E-078 Enhanced flow diversion for ruptured fusiform basilar artery aneurysm: case report

Introduction

Rupture of fusiform basilar aneurysm is typically fatal despite best efforts. We report good short-term outcome after endovascular basilar artery recontruction in a patient with fusiform basilar aneurysm who presented with acute subarachnoid haemorrhage.

Method

A previously healthy 65-year-old male presented to the emergency department acutely obtunded with massive subarachnoid haemorrhage (Hunt/Hess grade 5). CT angiography revealed an irregular fusiform aneurysm of the mid- and proximal basilar artery. The neurosurgery team requested endovascular treatment. The patient was admitted to the ICU and partially loaded on aspirin/clopidogrel over several days. At treatment, a guide catheter was placed in each vertebral artery (VA). Via the left, a Pipeline embolisation device was deployed across the diseased segment from the relatively normal-appearing distal basilar artery to the distal left VA. From the right, the proximal saccular aneurysm component outside the stent was loosely packed with coils using a prepositioned microcatheter. Finally, the right vertebral artery was sacrificed beyond PICA to eliminate flow into the aneurysm except across the stent.

Results

Post-treatment angiograms demonstrated good stent position (arrows, figure C, show the distal half of the stent), preserved distal basilar perfusion (figure B), loose packing of the proximal aneurysm with some contrast stagnation (arrow, figure B), and sacrifice of the right VA beyond PICA (not shown). A brain MRI five days later showed no new infarct (specifically, no evidence of brainstem perforator infarct). Subsequently, the patient slowly improved neurologically and was transferred to a rehabilitation facility after three weeks, with major neurologic deficits but following commands.

Conclusion

Endovascular basilar artery reconstruction by enhanced flow diversion may allow survival after severe subarachnoid haemorrhage from ruptured fusiform aneurysm.

Disclosures

F. Almaguel: None. P. Bouz: None. S. Basu: None. J. Jacobson: None.