PMC10374006_01
Preoperative angiography. (A) Three-dimensional angiography reveals a vertebrobasilar aneurysm. (B) Anteroposterior angiography measurement data shows the maximum outer diameter and the length of the aneurysm. (C) Lateral angiography reveals a vertebrobasilar aneurysm. (D) Anteroposterior angiography shows a slender right vertebral artery and occulded V4 segment.
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F1
Digital subtraction angiography revealed a fusiform aneurysm at the left vertebral artery V4 segment to the proximal segment of the basilar artery, with a maximum diameter and length of about 10 and 60 mm, respectively; the right vertebral artery was slender, and the right vertebral artery V4 segment was occluded (Figure 1).
High resolution magnetic resonance imaging before the operation. High resolution magnetic resonance imaging reveals a vertebrobasilar dissecting aneurysm (red arrow).
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F2
High resolution magnetic resonance imaging confirmed that the lesion was vertebrobasilar dissecting aneurysm (Figure 2).
Angiography during the operation. (A) The first flow diverter was released in the distal end of the aneurysm. (B) The second flow diverter was telescoped from the distal to the proximal. (C) Angiography after release of the two flow diverters showed retention of contrast agent in the aneurysm. The parent artery was patent. (D) Postoperative Dyna-CT showed that the two flow diverters were satisfactorily open.
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F3
Tubridge flow diverter (6.0 x 45 mm) was delivered and opened inside the first, and then released slowly by combining a push and tension-reduction technique. The two flow diverters overlapped by ~25 mm (Figures 3A, B). The angiography performed after the release of the flow diverter showed that the contrast agent was obviously retained in the aneurysm and the parent artery was patent [O'Kelly-Marotta (OKM)] grade B (Figure 3C). Dyna computed tomography showed that the patency of the two flow diverters was satisfactory, in good agreement with the parent artery, and the entire lesion was covered (Figure 3D).
Six-month follow-up angiography. (A) At the 6-month follow-up, anteroposterior angiography showed that the aneurysm was nearly completely occluded. (B) At the 6-month follow-up, lateral angiography reveals the aneurysm was nearly completely occluded.
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F4
Six months after the operation, the follow-up digital subtraction angiography showed that the aneurysm was almost completely occluded, with OKM grade C (Figure 4).