INTRAVASCULAR STENT AND ENDOVASCULAR COIL PLACEMENT FOR A RUPTURED FUSIFORM ANEURYSM OF THE BASILAR ARTERY - CASE-REPORT AND REVIEW OF THE LITERATURE

The authors demonstrate the technical Feasibility of using intravascul ar stents in conjunction with electrolytically detachable coils (Gugli elmi detachable coils [GDCs]) for treatment of fusiform, broad-based, acutely ruptured intracranial aneurysms and review the literature on e ndovascular approaches to ruptured aneurysms and cerebral stent placem ent, A 77-year-old man presented with an acute subarachnoid hemorrhage of the posterior fossa. A fusiform aneurysm with a broad-based neck m easuring 12 mm and involving the distal vertebral artery (VA) and prox imal third of the basilar artery (BA) was demonstrated on cerebral ang iography. The aneurysm was judged to be inoperable. Six days later a r epeated hemorrhage occurred. A 15-mm-long intravascular stent was plac ed across the base of the aneurysm in the BA and expanded to 4 mm to a ct as a bridging scaffold to create a neck. A microcatheter was then g uided through the interstices of the stent into the body and dome of t he aneurysm, and GDCs were deposited for occlusion. The arteriogram ob tained after stent placement demonstrated occlusion of the main dome a nd body of the aneurysm, The coils were stably positioned and held in place by the stent across the distal VA and BA fusiform aneurysm. Exce llent blood flow to the distal BA and posterior cerebral artery was ma intained through the stent. There were no new brainstem ischemic event s attributable to the procedure. No rebleeding from the aneurysm bad o ccurred by the 10.5-month followup evaluation, and the patient has exp erienced significant neurological improvement. Certain types of intrac ranial fusiform aneurysms may now be treated by combining intravascula r stent and GDC place ment for aneurysm occlusion via an endovascular approach. This is the first known clinical application of this novel a pproach in a ruptured cerebral aneurysm.