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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}mayo.edu

Abstract

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

Disclaimer: this video summarises a scientific article published by BMJ Publishing Group Limited (BMJ). The content of this video has not been peer-reviewed and does not constitute medical advice. Any opinions expressed are solely those of the contributors. Viewers should be aware that professionals in the field may have different opinions. BMJ does not endorse any opinions expressed or recommendations discussed. Viewers should not use the content of the video as the basis for any medical treatment. BMJ disclaims all liability and responsibility arising from any reliance placed on the content.

  • Aneurysm
  • Artery
  • Coil
  • Stent

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Footnotes

  • 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.

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