Domingo Ricardo A, Ramos-Fresnedo Andres, Ravindran Krishnan, Tawk Rabih G
Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA.
Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
J Neurointerv Surg. 2023 May;15(5):512. doi: 10.1136/neurintsurg-2022-019002. Epub 2022 May 20.
Endovascular treatment of recurrent basilar aneurysms is challenging due to significant changes in the configuration of the aneurysm and adjacent vessels from prior interventions.1 Coil compaction is a common cause of recurrence and alters the aneurysm morphology significantly.2-4 Stenting of the basilar artery into a posterior cerebral artery modifies the angles between these vessels.5 In this video, we discuss a combined approach via the anterior and posterior circulation for stent-assisted coiling of a recurrent basilar tip aneurysm (Video 1) . A patient in their 40s with a history of ruptured aneurysm underwent multiple endovascular interventions including coiling, stent-assisted coiling, and Woven Endobridge (WEB) device. The patient presented with worsening headaches and underwent treatment with stent-assisted coiling for recurrence. After encountering challenges with direct access from the basilar artery, a combined anterior and posterior circulation approach was used.6 The stent was deployed through the posterior communicating artery and a snare was used to navigate the complex anatomy. neurintsurg;15/5/512/V1F1V1Video 1 .
由于先前干预导致动脉瘤和相邻血管的形态发生显著变化，复发性基底动脉瘤的血管内治疗具有挑战性。1 弹簧圈压缩是复发的常见原因，会显著改变动脉瘤形态。2-4 将基底动脉支架置入大脑后动脉会改变这些血管之间的角度。5 在本视频中，我们讨论一种通过前后循环联合的方法对复发性基底动脉尖部动脉瘤进行支架辅助弹簧圈栓塞治疗（视频1）。一名40多岁有动脉瘤破裂病史的患者接受了包括弹簧圈栓塞、支架辅助弹簧圈栓塞和编织型血管内桥接（WEB）装置在内的多次血管内干预。该患者出现头痛加重，并接受了支架辅助弹簧圈栓塞治疗复发。在从基底动脉直接入路遇到困难后，采用了前后循环联合的方法。6 通过后交通动脉置入支架，并使用圈套器来应对复杂的解剖结构。神经介入手术；15/5/512/V1F1V1视频1。
