Objective and importance Giant fusiform aneurysms of the basilar artery are associated with a high rate of morbidity and mortality. Treatment of these lesions can be difficult especially when there are poor anatomic collaterals such as posterior communicating arteries. Often times these lesions have no acceptable treatment. We present a case of a patient with a large, symptomatic, fusiform basilar artery aneurysm successfully treated with a side by side, telescoping stent construct and coiling of the giant basilar artery aneurysm.
Clinical presentation A 56-year-old man presented with chief complaints of dysarthria and left-sided hemiparesis. MRI and conventional catheter based angiography revealed a dolichoectatic basilar artery with three large fusiform aneurysms throughout its length. Flow through the patient's aneurysm was successfully reduced with a side by side stent construct and coiling of the proximal aneurysm dilation. The patient experienced stabilization of his ischemic events and neurologic recovery.
Intervention and technique A total of eight Neuroform-2 4.5×30 mm stents were navigated and positioned from the proximal posterior cerebral arteries to the distal vertebral arteries in a side by side, telescoping manner. These were deployed simultaneously by two operators to oppose the stent struts as well as the arterial wall. Next, the proximal aneurysmal dilation was coiled to near occlusion.
Conclusion We present a novel, endovascular stenting technique for successfully treating symptomatic, giant basilar artery aneurysms. The above patient at 4 months was living independently with no further neurologic events or decline.
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Competing interests None.