PMC4728149_01
Case 1 imaging. a: Preoperative left vertebral angiogram showing the dissecting aneurysm. b, c: Three-dimensional rotation angiogram showing the dissection of the basilar trunk (b, antero-posterior view; c, cranio-caudal view). Note the all-around dilatation at the non-branching site of the artery, which demonstrated dissecting rather than saccular aneurysm. d: Left vertebral angiogram just after treatment.
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F1
Angiography revealed a BA trunk dissecting aneurysm (Fig. 1a-c). Therefore, SAC using a Leo stent (Balt, Montmorency, France) was then attempted on day 4 (Fig. 1d) with the approval of the hospital ethics committee.
Long-term follow-up of case 1. a-c: Left vertebral angiogram performed 1 year (a), 3 years (b), and 5 years (c) after the treatment. Note the gradual dilatation of the residual aneurysm (black arrows).
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F2
The 1-year follow-up angiography showed slight dilatation of the dissecting portion, and yearly angiography was continued for 5 years (Fig. 2a-c).
PMC4728149_02
Case 3 imaging. a, b: Preoperative left vertebral angiograms (a, antero-posterior view; b, lateral view). Note the dissecting aneurysm extending from the mid-basilar artery to the left vertebral artery. c: Placement of the Codman Enterprise VRD (Johnson & Johnson Codman, Miami, Florida, USA) through the dissecting aneurysm. Black arrowheads show the distal and proximal markers of the stent. d-f: Postoperative left vertebral angiograms (d, just after treatment; e, 1 month after treatment; f, 14 months after treatment). Note that the partial filling observed in (d) is no longer apparent in (e) (white arrows). However, slight dilatation of the coiled lumen can be observed in (f) (white arrowheads).
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F3
His head CT scan revealed an SAH, and a dissecting aneurysm extending from the left VA to the mid-BA trunk was detected on angiography (Fig. 3a, b). After the Enterprise VRD (Johnson & Johnson Codman, Miami, Florida, USA) was placed over the entire length of the lesion (Fig. 3c), coil embolization of the dilatation was completed while the partial filling of the dilating portion was still observed (Fig. 3d). On a second angiography 1 month after the treatment, partial filling of the dilating portion was no longer visible, which suggested good thrombosis of the cavities around the coils (Fig. 3e). Although a slight dilatation of the dissection lumen was observed on the follow-up angiography performed 14 months after surgery (Fig. 3f), we decided to continue close observation.