PMC7452632_01
(A) An axial CT-scan shows subarachnoid hemorrhage in the suprasellar cistern (B) A CT-angiograph shows a saccular aneurysm at the vertebrobasilar junction (C) A 2D right vertebral artery angiogram shows a wide-neck saccular aneurysm at the vertebrobasilar junction with basilar fenestration (red-arrows) (D) Coils within the aneurysm sac with patency of both the limbs (red-arrows) (E, F) Check-angiograms show complete aneurysm obliteration with normal distal flow.
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A computed tomography (CT) scan revealed a modified Fisher Grade IV subarachnoid hemorrhage (SAH) (Fig. 1A). A CT-angiography found a ruptured saccular VBJ aneurysm associated with a fenestrated BA (Fig. 1B). There was good contrast-filling in the distal BA and its branches (Fig. 1C). Subsequently, the aneurysm was coiled (Fig. 1D, E), and the final angiogram showed normal flow in both the fenestrated limbs and in the distal segment of the BA (Fig. 1F).
PMC7452632_02
(A) An axial plain CT-scan of the brain shows thick subarachnoid hemorrhage in the right sylvian fissure and perimesencephalic cistern (B) CT-angiography shows a saccular aneurysm in the vertebrobasilar junction with hypoplastic left vertebral artery (C) A 2D right subclavian angiogram shows severe stenosis at the origin of the right vertebral artery (D) Navigation of the distal access catheter into the right vertebral artery after balloon angioplasty.
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A CT-scan revealed a modified Fisher Grade IV SAH (Fig. 2A). The right VA was dominant, whereas the left was hypoplastic (Fig. 2B). Right femoral artery access was taken and a diagnostic angiogram was done, which showed type-II aortic arch with significant atheromatous changes, marked tortuosity of the proximal great vessels, severe stenosis at the origin of the right VA (Fig. 2C), and chronic occlusion of the right internal carotid artery. Subsequently, the distal access catheter was placed into the distal-most part of the V2 segment of the right VA (Fig. 2D). 2D right VA angiograms revealed a wide-neck saccular aneurysm at the right VBJ with AICA-PICA variant arising from its neck (Fig. 3A).
(A) A 2D right vertebral artery angiogram shows a wide-neck saccular aneurysm at the vertebrobasilar junction with AICA- PICA variant arising from its neck (B) Deployment of the braided stent from the basilar artery to the V4 vertebral artery segment covering the aneurysm (C) Coils within aneurysm sac with a stent in the parent artery (D) Final angiogram shows complete obliteration of aneurysm with normal flow in the AICA- PICA variant.
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Subsequently, the distal access catheter was placed into the distal-most part of the V2 segment of the right VA (Fig. 2D). 2D right VA angiograms revealed a wide-neck saccular aneurysm at the right VBJ with AICA-PICA variant arising from its neck (Fig. 3A). Traxcess 14 microguidewire. The Leo stent was then deployed from the BA to the V4 segment of VA (Fig. 3B). Subsequently, the aneurysm was coiled (Fig. 3C) without obliterating flow in the origin of the AICA-PICA variation (Fig. 3D).