Bilateral vertebral artery balloon occlusion for giant vertebrobasilar aneurysms

We describe the clinical presentation, radiological and clinical results in six consecutive patients with a giant vertebrobasilar aneurysm treated by bilateral vertebral artery balloon occlusion. Five patients presented with headache and signs of brain-stem compression and one with subarachnoid haem orrhage. In all patients vertebral artery balloon occlusion was performed. In four, this followed successful test occlusion, In one patient, who did n ot tolerate the test occlusion, a bypass from the external carotid to the p osterior cerebral artery preceded definitive vertebral artery occlusion. On e patient underwent bypass surgery prior to test occlusion. At 6-22 months follow-up three patients had a good functional outcome and showed unchanged size or shrinkage of the aneurysm on MRI. Three other patients died: one f rom recurrent haemorrhage, and two probably from delayed brainstem ischaemi a, The presence of two large posterior communicating arteries predicted goo d functional outcome, which was also related to the clinical condition at p resentation, and the degree of brain-stem compression and oedema on MRI. Bi lateral vertebral artery balloon occlusion can be considered in patients wi th otherwise untreatable giant vertebrobasilar aneurysms. If test occlusion is not tolerated, a surgical bypass to the posterior circulation can be co nsidered.