Endovascular Management of Basilar Artery Aneurysms Associated with Fenestrations
Civan Islaka,
Naci Kocera,
Fatih Kantarcia,
Isil Saatcid,
Omer Uzmab and
Bulent Canbazc
a Department of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
b Department of Anesthesiology and Reanimation, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
c Department of Neurosurgery, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
d Department of Radiology, Hacettepe University Medical Faculty, Ankara, Turkey
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FIG 1. 35-year-old woman with intractable headache.
A and B, Lateral (A) and oblique right (B) vertebral artery angiograms show a large-neck aneurysm.
C, Right vertebral artery oblique projection demonstrates residual filling after initial attempt.
D, Left vertebral artery injection image after the last embolization session demonstrates persistence of residual filling.
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FIG 2. 34-year-old man with Hunt and Hess grade 2 subarachnoid hemorrhage.
A, Right vertebral artery anteroposterior projection reveals a proximal basilar fenestration associated with aneurysm.
B, Fluoroscopic image during deployment of last coil shows neck remodeling.
C, Postembolization right vertebral artery injection image confirms total occlusion of the sac and patency of both loops of the fenestration.
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FIG 3. 30-year-old man with subarachnoid hemorrhage at presentation in 1994.
A and B, Digital subtraction angiograms in anteroposterior (A) and lateral (B) projections demonstrate a fenestration and an associated aneurysm.
C, Follow-up angiogram in lateral projection after GDC treatment shows total occlusion.
D, Angiogram obtained 6 months later reveals recanalization due to coil compaction.
E and F, Follow-up angiogram immediately after treatment (E) shows total occlusion of the aneurysm, which turned out to be partially recanalized on the 1-year follow-up angiogram (F).
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FIG 4. 41-year-old woman who presented with serious headaches.
A, Right anterior oblique projection shows a fenestration associated with an upwardly projecting midbasilar artery aneurysm.
B, Immediately after GDC occlusion, right anterior oblique angiogram confirms total occlusion.
C, One-year follow-up lateral angiogram shows that the occlusion is stable.
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FIG 5. 62-year-old woman with a Hunt and Hess grade 3 subarachnoid hemorrhage at presentation.
A, Left vertebral artery angiogram demonstrates fenestration and large-neck bilobed aneurysm at the proximal part. Note mild vasospasm of the basilar artery.
B and C, Postembolization left (B) and right (C) vertebral artery injection images show total occlusion of the aneurysm and smaller right-sided daughter branch of fenestration.
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