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Treatment of basilar tip aneurysms with horizontal PCA to PCA stent-assisted coiling: case series
  1. Spiros L Blackburn1,
  2. Yasha Kadkhodayan1,
  3. Eugenia Shekhtman2,
  4. Colin P Derdeyn1,
  5. DeWitte T Cross III1,
  6. Christopher J Moran1
  1. 1Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri, USA
  2. 2Department of Neurosurgery, New York University, New York, New York, USA
  1. Correspondence to Dr Spiros L Blackburn, Department of Radiology, 510 S. Kingshighway, St. Louis, MO 63110, USA; spirosblackburn{at}gmail.com

Abstract

Backgroun and objective Coiling of wide-necked basilar tip aneurysms is technically challenging and is often assisted by the placement of a stent. Stent placement in an anterograde fashion either with a single or Y-stent is typical. However, in some cases the posterior cerebral artery (PCA) angle of origin at the base of the aneurysm precludes anterograde catheterization. A series of patients with wide-necked basilar tip aneurysms treated with a single stent placed via the posterior communicating artery from PCA to PCA is presented.

Methods A retrospective database review was performed to identify all stent-coiled basilar tip aneurysms. Patients with attempted horizontal P1–P1 stenting via the posterior communicating artery were identified. Procedural imaging, follow-up angiography and clinical notes were reviewed.

Results P1–P1 stenting was attempted in 10 patients and was successful in eight. Angiographic follow-up was available in six patients, all of whom had >90% obliteration at last follow-up. There was one procedure-related subarachnoid hemorrhage that resulted in patient death. There were no cases of significant PCA stenosis on angiographic follow-up.

Conclusions This stenting technique is an effective way to treat wide-necked basilar tip aneurysms but is limited by the anatomy of the posterior communicating arteries and P1 segments.

  • Basilar artery
  • aneurysm
  • stent
  • coiling
  • coil
  • CT angiography
  • device

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Footnotes

  • Contributors SLB is the primary author of the paper. YK and ES collected data and edited the manuscript. DTC, CPD and CJM edited and revised the paper.

  • Competing interests None.

  • Ethics approval Ethical approval was obtained from Washington University IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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