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Combined anterior and posterior circulation approach for stent-assisted coiling of a recurrent basilar tip aneurysm
  1. Ricardo A Domingo,
  2. Andres Ramos-Fresnedo,
  3. Krishnan Ravindran,
  4. Rabih G Tawk
  1. Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
  1. Correspondence to Dr Rabih G Tawk, Neurosurgery, Mayo Clinic Hospital Jacksonville, Jacksonville, FL 32224, USA; tawk.rabih{at}


Endovascular treatment of recurrent basilar aneurysms is challenging due to significant changes in the configuration of the aneurysm and adjacent vessels from prior interventions.1 Coil compaction is a common cause of recurrence and alters the aneurysm morphology significantly.2–4 Stenting of the basilar artery into a posterior cerebral artery modifies the angles between these vessels.5 In this video, we discuss a combined approach via the anterior and posterior circulation for stent-assisted coiling of a recurrent basilar tip aneurysm (Video 1) . A patient in their 40s with a history of ruptured aneurysm underwent multiple endovascular interventions including coiling, stent-assisted coiling, and Woven Endobridge (WEB) device. The patient presented with worsening headaches and underwent treatment with stent-assisted coiling for recurrence. After encountering challenges with direct access from the basilar artery, a combined anterior and posterior circulation approach was used.6 The stent was deployed through the posterior communicating artery and a snare was used to navigate the complex anatomy.

Video 1
  • Aneurysm
  • Artery
  • Coil
  • Stent

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  • Contributors Concept and design: DRA, TRG. Materials and methods: DRA, TRG, RK. Software: R-FA, DRA. Visualization: R-FA. Drafting of the manuscript: DRA, TRG. Critical review: R-FA. Supervision: TRG.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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