To describe the experience of two challenging basilar tip aneurysms that involved the origins of bilateral SCAs and PCASs successfully treated with PulseRider bifurcation stent.
A large basilar tip aneurysm case that was successfully treated with PulseRider T-shaped bifurcation stent after a failed Y-stenting attempt.
Case description Both patients were treated as a part of ANSWER Trial. An early 70s female patient was found to have a broad-based large basilar tip aneurysm during her work up for right symptomatic carotid artery stenosis. The aneurysm incorporated bilateral PCAs and SCAs. Bilateral P1 and P2 segments showed extreme tortuosity, which made single or Y-stenting challenging. The aneurysm was first embolized with double microcatheter and balloon assisted techniques. However, it continued to grow from the large remnant. A Y-stenting attempt failed once due to the PCA tortuosity. The recanalized growing aneurysm measured 20mm in the largest dimension. A 10mm span T-shaped PulseRider was delivered through a 0.021 microcatheter and could be placed within the base of the recanalized aneurysm just above the PCA origins. A total of 25 coils were deployed into the aneurysm. The final angiogram showed complete obliteration of the aneurysm and patency of the PCAs and SCAs. Due to the large size and also aggressive coiling, the patient experienced worsening of mass effect to the midbrain and upper pons, which was successfully treated with steroid. Brain MRI showed FLAIR high signal in the cerebral peduncle and belly of the upper pons. No DWI high signal was found in bilateral PCA territories.
Another case was a late 50s female with a previously ruptured small wide-necked basilar tip aneurysm that incorporated the posterior wall of the basilar artery near the origins of PCAs and SCAs. In acute phase, the dome and bleb of the aneurysm was first embolized with balloon assist technique. However, the aneurysm recanalized from the remnant. The largest dimension of the recanalized aneurysm measured 6mm. An eight mm span T-shaped PulserRider was deployed with each tip placed into the PCAs. The wing of the PulseRider delineated the aneurysm neck for the subsequent embolization and the body also provided adequate protection for the embolization of the aneurysm base that incorporated the PCA and SCA origins. The aneurysm was successfully embolized with 10 coils.
Conclusion The PulseRider’s unique ability to protect bifurcation branches without catheterizing into those branches enabled the successful embolizations. The body of the pulseRider also provides some protection.
Disclosures S. Tateshima: 2; C; Pulsar Vascular. S. Seth: None. C. Liang: None. N. Patel: None. A. Ismail: None. D. Freeman: None. V. Szeder: None. R. Jahan: None. G. Duckwiler: None.
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