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Rapidly growing basilar dissecting aneurysm

Authors:
Jo Peluso at Universitair Ziekenhuis Leuven
Jo Peluso
Willem Jan van Rooij at AZ Turnhout
Willem Jan van Rooij
Menno Sluzewski at Elisabeth-Tweesteden Hospital
Menno Sluzewski
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Abstract

A 58-year-woman was admitted in poor clinical condition (Hunt and Hess grade V) after subarachnoid and intraventricular haemorrhage. She was intubated, and hydrocephalus was treated with ventricular drainage. Angiography on day 3 showed a small dissecting aneurysm of the distal basilar artery (fig 1A). Treatment was judged not possible. She had a recurrent haemorrhage on day 14, and a second angiography on day 23 revealed that the size of the aneurysm had increased (fig 1B). At that time, it was decided to treat the aneurysm with stent-assisted coiling. Angiography at the time of treatment on day 30 showed that the aneurysm had enlarged again (fig 1C). A stent was placed in the basilar artery and right posterior cerebral artery covering the neck of the aneurysm, and the aneurysm was occluded with coils through the mazes of the stent. Follow-up angiography 6 months later showed stable complete occlusion of the aneurysm (fig 1D, arrows point to proximal and distal stent markers; the stent itself is invisible). The patient’s clinical condition had improved markedly with only some cognitive impairment and memory disturbances. Figure 1 (A) Angiography 3 days after a subarachnoid and intraventricular haemorrhage, showing a small dissecting aneurysm of the distal basilar artery; (B) angiography on day 23 showing an increase in size of the aneurysm; (C) angiography on day 30 showing a ...
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Rapidly growing basilar dissecting aneurysm.
Peluso JP, van Rooij WJ, Sluzewski M
J Neurol Neurosurg Psychiatry in press
Neurological Picture
A 58-year-woman was admitted in poor clinical condition (Hunt and Hess grade V)
after subarachnoid and intra ventricular hemorrhage (A,B). She was intubated and
hydrocephalus was treated with ventricular drainage. Angiography on day 3 showed
a small dissecting aneurysm of the distal basilar artery (C). Treatment was judged not
possible. She had a recurrent hemorrhage on day 14 and second angiography on
day 23 demonstrated increased size of the aneurysm (D). At that time, it was decided
to treat the aneurysm with stent assisted coiling. Angiography at the time of treatment
on day 30 showed that the aneurysm had enlarged again (E). A stent was placed in
the basilar artery and right posterior cerebral artery covering the neck of the
aneurysm (F,G) and the aneurysm was occluded with coils through the mazes of the
stent. Follow up angiography 6 months later showed stable complete occlusion of the
aneurysm (G, arrows point to proximal and distal stent markers; the stent itself is
invisible). The patients’ clinical condition had improved markedly with only some
cognitive impairment and memory disturbances.
... We conducted a thorough literature review and found 14 reported cases with growing basilar dissecting aneurysms verified by radiological evidence (Table 1). [1][2][3][4][5][7][8][9][10] Among the 14 patients, as listed in the Table 1, conservative treatment was primarily considered in 13 patients. Unfortunately, of the 6 patients who solely managed by conservative treatment, 3 eventually died of subarachnoid hemorrhage, 2 died as a result of brain stem compression, and only 1 did well. ...
... The stent-assisted coiling seems to be a feasible alternative treatment option for the dissecting aneurysms involving the basilar trunk, while preserving the patency of the parent arteries. 4,6,10 The stent served as a buttress allows for a higher packing density during coiling. This technique remodels the parent artery and redirects blood flow away from the aneurysm, which thereafter promotes thrombus formation within the aneurysm. ...
Growing Dissecting Aneurysm of Basilar Trunk Treated with Stent-assisted Coiling
Article
  • Sep 2014
Growing basilar dissecting aneurysm is a scarce but increasingly recognized entity, accounting for a significant risk of death and disability. Controversy exists regarding the optimal management. A 61-year-old man presented with dysarthria and left hemiparesis attributable to a basilar trunk dissecting aneurysm. Antiplatelet therapy was instituted, and the patient's clinical condition markedly improved. However, he developed severe headache, dysarthria, and left hemiparesis 35 days later. Angiography revealed significant enlargement of the aneurysm, and stent-assisted coiling was then uneventfully performed. The patient remained clinically stable with only mild left-sided hemiparesis at the 2-year clinical follow-up.
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Reconstructive Endovascular Treatment of Fusiform and Dissecting Basilar Trunk Aneurysms with Flow Diverters, Stents, and Coils
Article
Full-text available
  • Aug 2012
  • AM J NEURORADIOL
Background and purpose: Patients with fusiform basilar trunk aneurysms have a poor prognosis. Reconstructive endovascular therapy is possible with modern devices. We describe the clinical presentation, radiologic features, and clinical outcome of 13 patients with fusiform basilar trunk aneurysms treated with flow diverters, stents, and coils. Materials and methods: Of the 13 patients, 7 were men and 6 were women with a mean age of 59.7 years. Clinical presentation was SAH in 3 patients, mass effect on the brain stem in 4 patients, vertebral artery dissection in 1 patient, and the aneurysm was an incidental finding in 5 patients. Mean aneurysm size was 21 mm. All except 1 were large or giant aneurysms. Nine aneurysms were partially thrombosed. Results: Stents were used in all 13 patients, in 2 patients with additional flow diverters and in 11 patients with additional coils. In 4 patients, 1 vertebral artery was subsequently occluded with coils to decrease flow into the aneurysm. Of 13 patients, 9 had a good outcome with adequate aneurysm occlusion and stable size on follow-up of 6-72 months. One of 3 patients who presented with SAH died of a rebleed 1 month later. One other patient died soon after treatment of in-stent thrombosis, and another patient became mute after treatment. In 2 of 3 patients who presented with symptoms of mass effect, there was improvement at a follow-up of 6-24 months. Conclusions: Reconstructive endovascular therapy of fusiform and dissecting basilar trunk aneurysms is feasible but carries substantial risks. The safety and effectiveness in relation to natural history has not yet been elucidated.
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