A novel endovascular treatment of a wide-necked basilar apex aneurysm by using a Y-configuration, double-stent technique

Abstract

Wide-necked bifurcation aneurysms remain a formidable challenge to the neuroendovascular surgeon. A 36-year-old woman with a wide-necked basilar bifurcation aneurysm was unsuccessfully treated by endovascular methods, despite the use of the balloon-remodeling technique. Successful coiling was ultimately achieved by use of a Y-configuration double stent-assisted technique. This novel method of using self-expanding stents may represent a significant advance in the management of basilar apex and other bifurcation aneurysms.

Fig 1.

Bilateral oblique views (A and B) of the 3D rotational angiogram shows the aneurysm neck incorporating the origins of both PCAs. The aneurysm neck is dilated in the anteroposterior direction.

Fig 2.

Final configuration of the dual stents with the distal end of each Neuroform stent in a PCA and the proximal ends telescoped within each other in the midbasilar artery. A, First stent deployed. B, Second stent through interstices.

Fig 3.

Intraprocedural roadmap showing sequence of stent deployment. A, Anteroposterior left vertebral artery angiogram, showing placement of the guidewire in the right PCA before deployment of the initial Neuroform stent. B, Anteroposterior left vertebral artery angiogram, showing successful deployment of the first Neuroform stent and selection of the left PCA through the interstices of the first stent by the guidewire.

Fig 4.

Anteroposterior left vertebral artery angiogram with (A) and without (B) native anatomy, showing successful deployment of the second Neuroform stent with the distal end in the left P1 segment and the proximal end telescoped within the first stent in the distal basilar artery. Note the position of the microcatheter that has traversed the interstices of the stents to lie within the aneurysm itself.

Fig 5.

Anteroposterior left vertebral artery angiogram with (A) and without (B) native anatomy, showing complete obliteration of the aneurysm with preservation of bilateral PCAs. Lateral left vertebral artery angiogram with (C) and without (D) native anatomy, showing a small amount of opacification within the coil loops at the neck of the aneurysm. Also note loops of coil excluded from basilar terminus by stents filling the anterior and posterior “pouches” of the aneurysm at the basilar artery terminus.