Management of ruptured aneurysmal subarachnoid hemorrhage with multiple basilar trunk aneurysms using a flow-diverter stent: A case report

Abstract

Ruptured aneurysmal subarachnoid hemorrhage associated with multiple basilar trunk aneurysms represents a rare clinical condition. Endovascular intervention stands as the preferred therapeutic approach. We present the case of a 35-year-old patient with subarachnoid hemorrhage and three consecutive basilar trunk aneurysms. Utilizing a flow-diverter stent, we achieved simultaneous occlusion of all 3 aneurysms, performed 2 hours post dual antiplatelet therapy (comprising salicylic acid 300 mg and ticagrelor 180 mg). Sustained resistance to clopidogrel necessitated the subsequent 3 months, followed by single antiplatelet therapy. At the 1-month follow-up, the patient demonstrated a favorable clinical course, devoid of cerebral infarction, and evidenced unobstructed stent patency upon brain magnetic resonance imaging.

Keywords: Flow diverter stent; Multiple basilar trunk aneurysms; Subarachnoid hemorrhage.

Fig. 1

Subarachnoid hemorrhage around the pons and brain stem (red arrows).

Fig. 2

Multiple basilar trunk aneurysms. Red, yellow, and orange arrows indicated basilar trunk aneurysms, whereas blue one indicated small vertebral aneurysm.

Fig. 3

DSA image showed that stent covered all 3 aneurysms. Red and blue arrows indicated distal and proximal ends of the stent, respectively, whereas orange arrows indicated aneurysms.

Fig. 4

One-month follow-up MRI without obstruction within the stent.