Sakata Hiroyuki, Ezura Masayuki, Abe Takatsugu, Ishida Tomohisa, Endo Hidenori, Inoue Takashi, Endo Toshiki, Uenohara Hiroshi, Tominaga Teiji
Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Miyagi, Japan.
Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
J Neuroendovasc Ther. 2021;15(12):823-828. doi: 10.5797/jnet.tn.2020-0155. Epub 2021 Apr 22.
Endovascular treatment for complex wide-necked basilar tip aneurysms is challenging. Multiple stenting may be an option to deal with such aneurysms; however, the risk of ischemic complications is reported to be relatively high. Here, we report a case of unruptured basilar tip aneurysm treated using the intentional stent herniation technique to preserve the aneurysmal neck branches.
A 65-year-old woman presented with a growing unruptured basilar tip aneurysm associated with bilateral posterior cerebral arteries (PCAs) arising from the aneurysmal dome. We intentionally selected a large-sized Neuroform Atlas stent (Stryker, Kalamazoo, MI, USA) compared to the parent artery and deployed it along the right PCA to the basilar artery. The stent was herniated into the aneurysmal dome near the origin of the left PCA, resulting in the preservation of the left PCA. Successful coil embolization was achieved with acceptable obliteration.
The intentional stent herniation technique may be an effective approach to treat complex wide-necked basilar tip aneurysms.
对复杂宽颈基底动脉尖部动脉瘤进行血管内治疗具有挑战性。多重支架置入可能是处理此类动脉瘤的一种选择；然而，据报道缺血性并发症的风险相对较高。在此，我们报告一例未破裂基底动脉尖部动脉瘤的病例，该病例采用了有意的支架疝入技术以保留动脉瘤颈部分支。
一名65岁女性，患有一个不断增大的未破裂基底动脉尖部动脉瘤，该动脉瘤与双侧大脑后动脉（PCA）相关，PCA从动脉瘤穹隆部发出。与母动脉相比，我们有意选择了一个大型的Neuroform Atlas支架（史赛克公司，美国密歇根州卡拉马祖），并将其沿右侧PCA向基底动脉展开。该支架疝入到左侧PCA起始部附近的动脉瘤穹隆部，从而保留了左侧PCA。通过可接受的闭塞程度实现了成功的弹簧圈栓塞。
有意的支架疝入技术可能是治疗复杂宽颈基底动脉尖部动脉瘤的一种有效方法。
