Thrombosis of a fusiform intracranial aneurysm induced by overlapping neuroform stents: case report

Abstract

Objective: To present a case of a true fusiform basilar artery aneurysm that underwent spontaneous thrombosis after placement of two overlapping Neuroform stents (Boston Scientific/Target, Fremont, CA).

Clinical presentation: A 45-year-old woman with transient syncopal episodes experienced a fall and presented to the emergency room. Incidentally, a non-contrast head computed tomographic scan and digital subtraction angiography demonstrated an unruptured, fusiform mid-basilar artery aneurysm.

Intervention: Endovascular treatment was initiated by using a stent-assisted coil embolization technique with placement of a self-expanding, dedicated intracranial, Neuroform stent in the basilar artery across the aneurysm's fusiform neck. Attempts to access the aneurysm for coil embolization resulted in transient migration of the stent into the aneurysm sac. A second Neuroform stent was advanced in telescoping fashion for salvage and stable coverage across the entire aneurysm; therefore, coil embolization was deferred to allow stent endothelialization. After 6 weeks on dual antiplatelet therapy, the patient presented with transient ischemic symptoms suggesting top of the basilar artery syndrome. Subsequent magnetic resonance imaging scans and angiography indicated circumferential thrombus formation in the aneurysm sac but patent flow in the basilar artery. A computed tomographic scan at 6 months and digital subtraction angiography at 12 months confirmed complete thrombosis of the fusiform mid-basilar artery aneurysm with basilar artery reconstruction.

Conclusion: Overlapping Neuroform stents may induce spontaneous thrombosis of intracranial aneurysms and facilitate parent artery reconstruction through flow remodeling and stent endothelialization. Double stent placement may be a viable option in dissecting or fusiform intracranial aneurysms that are not amenable to open surgical treatment or endovascular coil embolization.