PMC7398407_01
a The MRI indicated an aneurysm in front of the middle segment of the basilar artery. b Control DSA indicated near complete occlusion of the aneurysm. Ten years later, the patient presented with SAH suddenly (c) and DSA confirmed recurrence of the aneurysm (d). e The aneurysm was then treated again with robust packing of coils and an Enterprise stent. f Despite all these efforts, the coils were compacted and inflow zone was again patent as revealed by DSA
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Fig1
An unruptured basilar artery aneurysm was found due to a history of headaches in a 52-year-old male (Fig. 1a). Control angiography indicated near complete occlusion of the aneurysm, and the patient was free from any neurological deficit (Fig. 1b). Ten years later, the patient suddenly presented with subarachnoid hemorrhage (SAH) (WFNS grade 5) (Fig. 1c) and the digital subtraction angiography (DSA) confirmed recurrence of the aneurysm (Fig. 1d). After excluding the need to place an external ventricular drainage (EVD), the ruptured aneurysm was then treated by SAC with an Enterprise sized 4.5 mm x 22 mm 3 days after the ictus of SAH (Fig. 1e). Follow-up DSA 9 months later manifested with persist filling of contrast in the inferior portion of the aneurysm (Fig. 1f).
a CTA on admission suggested the recurrence of the aneurysm with fusiform morphology. b The distal end of the PED was deployed proximal to the distal end of the previous Enterprise stent. c Dyna-CT indicated that the entire PED was deployed within the Enterprise. d Adjunctive coiling was performed to secure the aneurysm. Right anterior oblique (e) and lateral view (f) of DSA indicated complete occlusion of the aneurysm on follow-up 6 months later
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Fig2
CTA on admission indicated that the aneurysm was fusiform in morphology, possibly a dissecting aneurysm (Fig. 2a). However, for this aneurysm with a stent in parent artery, we deployed a 4 x 16-mm sized PED in situ and made sure that the distal end of PED was proximal to the strut of the Enterprise stent so that the PED would not be stuck at the struts of Enterprise (Fig. 2b). As a result, the whole length of PED was within the Enterprise (Fig. 2c) and worked as an inner layer while the Enterprise acted as a scaffold. California, USA)) (Fig. 2d). After the procedure, the patient recovered from general anesthesia smoothly without any neurological deficit. The patient was treated with dual antiplatelet therapy which consisted of aspirin (100 mg) and clopidogrel (75 mg). Clopidogrel was discontinued at latest follow-up (6 month), and the aspirin (100 mg) was continued for life. DSA follow-up on 6 months showed complete obliteration of the aneurysm, and the patient was symptom free (mRS 0) (Fig. 2e, f).