PMC6350029_01
(A) Pretreatment T2-WI (weighted imaging) showing a partially thrombosed aneurysm in front of the pons with marked compression on the pons, (B) 6-month follow-up T2-WI showing significant shrinkage of the aneurysm, 1-year follow-up T2-WI (C) showing nearly complete shrinkage of the aneurysm, (D) 1-month follow-up T1-WI showing aneurysm thrombosis, 1-year follow-up T1-WI (E) showing complete shrinkage of the aneurysm.
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F1
Although the neurological examinations did not detect any neurological deficits, the computed tomographic (CT) and magnetic resonance images (MRIs) showed a partially thrombosed giant VBJ aneurysm in front of the pons with marked compression on the pons (Fig. 1A). Although the right AICA (anterior inferior cerebellar artery) was not observable nor was any retrograde flow in the angiography, 6-month and 1-year follow-up T2-weighted MRIs showed no ischemic lesions, and there was significant shrinkage of the thrombosed aneurysm with resolution of the prior compression (Figs. 1B and 1C). Furthermore, 1-month and 1-year follow-up T1-weighted MRIs apparently showed the aneurysm thrombosis and the shrinkage (Figs. 1D and 1E).
Pretreatment vertebral angiography showing a giant vertebrobasilar fusiform aneurysm.
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F2
Cerebral angiography confirmed the giant VBJ aneurysm involving the bilateral vertebral arteries (VAs) and the lower third of the basilar artery (BA) (Fig. 2).
Left fenestrated VA was occluded with coils slightly distal to the origin of the PICA (posterior inferior cerebellar artery).
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F3
After the introduction of general anesthesia, a 6-French (Fr) ultra-long guiding sheath to perform as a guiding catheter was inserted into the right vertebral artery through the right femoral artery, and a 5-Fr ultra-long guiding sheath was inserted into the left VA through the left femoral artery. After systemic heparinization within the target 250-300 s of activated clotting time (ACT) was achieved, the fenestrated left VA was occluded with coils slightly distal to the origin of the left posterior inferior cerebellar artery (Fig. 3).
Cone-beam CT image showing the telescopically deployed PEDs.
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F4
Two PEDs, first a 3.5 x 35-mm PED and then a 3.75 x 35-mm PED were telescopically deployed from the tip of the BA to the right VA to fully cover the aneurysm sac (Fig. 4).
Diagram showing the anatomical relationship of the deployed PEDs and coil occlusion of the left VA.
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F5
The diagram shows the anatomical relationship of the deployed PEDs and coil occlusion of the left VA (Fig. 5).
Six-month follow-up angiography showing complete aneurysm occlusion with the preservation of antegrade flow of the posterior circulation.
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F6
The angiography at that time showed complete aneurysm occlusion with preservation of the antegrade flow of the BA (Fig. 6).