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Basilar Artery Bifurcation Aneurysm: Retrograde Access via the Posterior Communicating Artery to the Basilar Artery Bifurcation for Stent-Assisted Recoiling of a Wide-Necked Aneurysm

  • Christian RothEmail author
  • Stefan Pfleiderer
Living reference work entry
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Abstract

A 42-year-old female patient was treated for acute subarachnoid hemorrhage (SAH) due to the rupture of a broad-based aneurysm on the basilar artery (BA) bifurcation. The aneurysm was occluded with coils in the acute phase using a balloon-remodeling technique and a neck remnant was intentionally left because the neck could not be fully controlled without implanting a stent. The follow-up DSA 6 months later showed that the coils had compacted and the aneurysm had grown. Since the wide neck of the aneurysm included both P1 segments of the posterior cerebral arteries (PCAs), using a single stent which would cover just one of the P1 segments would not have provided sufficient control of the aneurysm neck. Due to coil loops near the aneurysm base, neither an intra-aneurysmal stent nor an intrasaccular occlusion device were considered feasible. The patient’s prominent posterior communicating artery (PcomA) on the right-hand side was clearly visible on CTA and DSA images. The aneurysm was retreated by placing a 2/18 mm LEO+ Baby stent (Balt Extrusion) from the left P2/P1 segment and the BA bifurcation to the right P1 segment with access from the ICA/PcomA on the right-hand side, followed by additional coil occlusion. The procedure was carried out under general anesthesia with no technical or clinical complications, and the patient was discharged home 2 days after the treatment. MRI/MRA follow-up after 6 months showed a stable aneurysm occlusion. Stent-assisted coil occlusion of basilar artery bifurcation aneurysms with access via the PcomA as a technical nuance is the main topic of this chapter.

Keywords

Basilar artery bifurcation aneurysm Stent-assisted coiling Posterior communicating artery access LEO+ Baby 

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© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Klinik für Diagnostische und Interventionelle NeuroradiologieKlinikum Bremen-MitteBremenGermany
  2. 2.Institut für Diagnostische und Interventionelle RadiologieKlinikum ReinkenheideBremerhavenGermany

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