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Research ArticleINTERVENTIONAL

Large Basilar Apex Aneurysms Treated with Flow-Diverter Stents

V. Da Ros, J. Caroff, A. Rouchaud, C. Mihalea, L. Ikka, J. Moret and L. Spelle
American Journal of Neuroradiology June 2017, 38 (6) 1156-1162; DOI: https://doi.org/10.3174/ajnr.A5167
V. Da Ros
aFrom the Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy (V.D.R.), Policlinico Tor Vergata, Rome, Italy
bInterventional Neuroradiology NEURI Center (V.D.R., J.C., A.R., C.M., L.I., J.M., L.S.), Hôpital Bicêtre, Le Kremlin Bicêtre, France
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J. Caroff
bInterventional Neuroradiology NEURI Center (V.D.R., J.C., A.R., C.M., L.I., J.M., L.S.), Hôpital Bicêtre, Le Kremlin Bicêtre, France
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A. Rouchaud
bInterventional Neuroradiology NEURI Center (V.D.R., J.C., A.R., C.M., L.I., J.M., L.S.), Hôpital Bicêtre, Le Kremlin Bicêtre, France
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C. Mihalea
bInterventional Neuroradiology NEURI Center (V.D.R., J.C., A.R., C.M., L.I., J.M., L.S.), Hôpital Bicêtre, Le Kremlin Bicêtre, France
cDepartment of Neurosurgery (C.M.), University of Medicine and Pharmacy “Victor Babes,” Timisoara, Romania
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L. Ikka
bInterventional Neuroradiology NEURI Center (V.D.R., J.C., A.R., C.M., L.I., J.M., L.S.), Hôpital Bicêtre, Le Kremlin Bicêtre, France
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J. Moret
bInterventional Neuroradiology NEURI Center (V.D.R., J.C., A.R., C.M., L.I., J.M., L.S.), Hôpital Bicêtre, Le Kremlin Bicêtre, France
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L. Spelle
bInterventional Neuroradiology NEURI Center (V.D.R., J.C., A.R., C.M., L.I., J.M., L.S.), Hôpital Bicêtre, Le Kremlin Bicêtre, France
dUniversité Paris-Sud XI (L.S.), Le Kremlin-Bicêtre, France.
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    Fig 1.

    A, DSA shows a ruptured large BAA (10 × 10 mm; neck, 4.4 mm). B, Aneurysmal embolization was performed with the balloon-remodeling technique. C, Six-month DSA follow-up shows a significant neck recanalization (5 mm × 6 mm). D, At the 9-month follow-up, a second coiling remodeling technique associated with the deployment of a FRED flow-diverter stent across the right PCA was performed. E and F, The 24-hour postprocedural MR imaging, with DWI and ADC map, shows the presence of a small ischemic right cerebellar lesion. G, At 21-month DSA follow-up, both covered superior cerebellar arteries were not visualized, and the persistence of complete BAA occlusion was confirmed (mRR class I; mRS, 0).

  • Fig 2.
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    Fig 2.

    A, DSA shows the remnant of a wide-neck, large BAA aneurysm that involved both superior cerebellar arteries and the left P1 segment, with a 5-mm right superior cerebellar artery fusiform aneurysm, and a fetal origin of the right PCA, treated with a simple coiling. B, Six weeks later, the remnant was treated with a Pipeline stent. C, Twelve-month and D, 24-month follow-up DSA reveal complete aneurysmal occlusion (mRR class I).

  • Fig 3.
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    Fig 3.

    A, DSA shows a wide-neck, large BAA aneurysm (B) treated in a single session with coiling and a Silk flow-diverter stent across the left PCA. C and D, MR imaging shows the presence of a midbrain hematoma 12 hours after the treatment. E, Anteroposterior view DSA shows residual filling at the level of the aneurysmal neck. A second Pipeline flow diverter was then deployed. F, The 2-week DSA follow-up shows complete aneurysmal sac occlusion (mRR class I).

  • Fig 4.
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    Fig 4.

    A, The initial DSA demonstrates a wide-neck, large BAA involving the origin of both PCAs and superior cerebellar arteries (B) treated with a stent-assisted coiling technique (Neuroform 3.5 mm × 20 mm). C, The 18-month DSA follow-up reveals an aneurysmal recurrence at the level of the neck. D, A Pipeline stent was used to treat the neck remnant with (E) adequate aneurysm occlusion at 15-month DSA follow-up (mRR class IIIa) demonstrated in the working projection. F, The compression test performed confirms the result.

  • Fig 5.
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    Fig 5.

    A, The preoperative DSA shows a large, wide-neck BAA, twice partially coiled in an emergency setting, responsible for a chiasmal compression syndrome. B, Additional coiling of the sac remnant occurred and a subsequent flow-diverter stent (FRED 3.5 mm × 22–16 mm) was deployed across the right P1 segment. C, Twelve-month and D, 24-month DSA follow-up demonstrate adequate BAA occlusion (mRR class IIIa), and the visual field was completely recovered.

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American Journal of Neuroradiology: 38 (6)
American Journal of Neuroradiology
Vol. 38, Issue 6
1 Jun 2017
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Cite this article
V. Da Ros, J. Caroff, A. Rouchaud, C. Mihalea, L. Ikka, J. Moret, L. Spelle
Large Basilar Apex Aneurysms Treated with Flow-Diverter Stents
American Journal of Neuroradiology Jun 2017, 38 (6) 1156-1162; DOI: 10.3174/ajnr.A5167

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Large Basilar Apex Aneurysms Treated with Flow-Diverter Stents
V. Da Ros, J. Caroff, A. Rouchaud, C. Mihalea, L. Ikka, J. Moret, L. Spelle
American Journal of Neuroradiology Jun 2017, 38 (6) 1156-1162; DOI: 10.3174/ajnr.A5167
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  • The ’bendy' basilar: progressive aneurysm tilting and arterial deformation can be a delayed outcome after coiling of large basilar apex aneurysms
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