PMC10185358_01
Pre- and postoperative findings of PulseRider-assisted coil embolization and stent-assisted coil embolization 16 years after initial treatment. The anterior view (A) and lateral view (B) of digital subtraction angiography (DSA) show the recanalization of the basilar tip aneurysm with an anterior bleb (white arrow). The anterior view (C) and lateral view (D) of the X-ray photograph show the deployed T-shaped PulseRider (white arrow). The anterior view (E) and lateral view (F) of DSA demonstrate appropriate aneurysm obliteration after PulseRider-assisted coil embolization. The anterior view (G) and lateral view (H) of DSA show the recanalization of the basilar tip aneurysm at 6-month follow-up of PulseRider-assisted coil embolization.
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Digital subtraction angiography (DSA) at our hospital revealed a large BTA with an anterior bleb, which had maximum diameters of 16 mm at the dome and 8.5 mm at the neck (Fig. 1A, B). The previous coils were compacted upward and backward (Fig. 1C, D). A microcatheter (Prowler Select Plus, Cerenovus) was guided from the left vertebral artery (VA) to the basilar artery (BA), and a T-shaped PulseRider was successfully deployed in a hybrid-type configuration: the right leaf in the right posterior cerebral artery (PCA) and the left leaf in the aneurysm (Fig. 1C, D). PulseRider from the right VA. Thus, we performed an effective PulseRider-assisted coil embolization. The PulseRider was detached after coiling. Postoperative DSA showed appropriate occlusion, which was equivalent to Raymond occlusion classification class II (Fig. 1E, F). Magnetic resonance angiography at 6-months follow-up revealed the fourth recurrence of the aneurysm, which required additional treatment (Fig. 1G, H).
Schema of the treatment method. Previously deployed PulseRider and coil (A). A micro-guide wire is inserted into the right posterior cerebral artery (PCA) through PulseRider (B). Two microcatheters for coiling are navigated into the aneurysm (C), and an additional coil is inserted (D). A microcatheter for stenting is inserted into the right PCA after coiling (E), and the stent is deployed from the right PCA to the basilar artery through PulseRider (F).
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CA, USA) was guided to the right PCA (Fig. 2A, B). Crossing the lesion with the micro-guide wire through the PulseRider was easy. Subsequently, two microcatheters were inserted for coiling to the aneurysm through the PulseRider from the right VA (Fig. 2C). Finally, a microcatheter for stenting (Prowler Select Plus) was navigated to the right PCA, and Enterprise 2 was deployed between the right P2 segment of the PCA and BA after coil embolization (Figs. 2D, E, F and 3A, B).
Postoperative findings after stent-assisted coil embolization. The anterior view (A) and lateral view (B) of the X-ray photograph show an additional stent (arrowhead) and a previously deployed T-shaped PulseRider (white arrow). Anterior view (C) and lateral view (D) of digital subtraction angiography (DSA) showing appropriate aneurysm obliteration after additional stent-assisted coil embolization. Anterior view (E) and lateral view (F) of DSA taken 6 months later showing no recanalization.
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Finally, a microcatheter for stenting (Prowler Select Plus) was navigated to the right PCA, and Enterprise 2 was deployed between the right P2 segment of the PCA and BA after coil embolization (Figs. 2D, E, F and 3A, B). Postoperative DSA showed appropriate occlusion equivalent to Raymond occlusion classification class II, and no complications such as the displacement of the PulseRider or sagging were observed (Fig. 3C, D). DSA after 6 months showed no obvious recurrence, and the dose of dual antiplatelet therapy was tapered off thereafter (Fig. 3E, F).
Anterior view of digital subtraction angiography three-dimensional rotational angiography showing significant angular change. The angle between the right posterior cerebral artery and basilar artery was approximately 80  before stent-assisted coil embolization (A). The angle changed to approximately 105  after the treatment, and angular remodeling over 20  was observed (B). The angle between the basilar artery and the aneurysm was approximately 170  before stent-assisted coil embolization (C). The angle changed to approximately 150  after the treatment, and angular remodeling of 20  was observed (D).
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Angular remodeling between the right PCA and BA was observed after the treatment (Fig. 4).