PMC8769387_01
Preoperative and postoperative images (A: anteroposterior view, B: lateral view). DSA shows a large aneurysm at the BA tip. (C) Volume-rendering image of 3DRA shows that the bilateral posterior cerebral arteries arose from the aneurysm dome. (D) A maximum intensity projection image of cone-beam computed tomography after deployment of a Y-configuration stent in a cross-placement with LVIS and LVIS Jr. stents. A microcatheter (white arrow head) was inserted into the aneurysm using the stent-jail technique. Final view of the initial treatment (E: anteroposterior view, F: lateral view). BA: basilar artery, DSA: digital subtraction angiography, 3DRA: three-dimensional rotational angiography.
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F1
After the placement of guiding catheters in the bilateral vertebral arteries with systemic heparinization, digital subtraction angiography (DSA) and three-dimensional rotational angiography (3DRA) were performed (Figs. 1A-1C). Aliso Viejo, CA, USA). After imaging with cone-beam computed tomography with diluted contrast dye (Fig. 1D), coil embolization was initiated through a jailed microcatheter. The procedure was completed with sufficient patency of each vessel branch and almost total occlusion of the aneurysm (Figs. 1E and 1F).
(A) Diffusion-weighted images just after the initial embolization. (B-D) Close-up T2-weighted images just after the initial surgery (B), 2 months later (C), and 4 months later (D). The maximum diameters were 21 mm (B), 21 mm (C), and 24 mm (D), respectively. White arrow indicates midbrain edema newly appeared due to aneurysm compression.
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F2
The postoperative course was relatively uneventful, except for the occurrence of perforator vessel infarction (Figs. 2A and 2B). Two months after discharge, the patient showed transient diplopia and MRI showed mild perianeurysmal edema without aneurysm enlargement (Fig. 2C). T2-weighted imaging revealed mild enlargement of the aneurysm (maximum diameter, 24 mm) and perianeurysmal mesencephalic edema resulting from compression of the aneurysm without hydrocephalus and any new hemorrhagic or ischemic lesion (Fig. 2D).
DSA anteroposterior views before (A) and after (B) the second stent-assisted coil embolization. White arrow indicates minor recurrence of aneurysm neck. Close-up T2-weighted images before (C) and 6 months (D) after additional stent-assisted coil embolization. DSA: digital subtraction angiography.
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F3
DSA revealed minor recanalization around the aneurysmal neck without body filling (Fig. 3A). Levodopa administration was also continued because MRI continued to demonstrate perianeurysmal edema without apparent worsening (Figs. 3C and 3D).