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Basilar Artery Bifurcation Aneurysm: Giant Incidental Basilar Artery Bifurcation Aneurysm, Treated by Stent-Assisted Coil Occlusion Using Two Crossing pCONus1 Aneurysm Bridging Devices and Two Crossing Solitaire Stents Deployed in Telescoping Fashion; Four Treatment Sessions, Resulting in Permanent Aneurysm Occlusion and Good Clinical Outcome

  • Marta Aguilar Pérez
  • Muhammad AlMatter
  • Hans Henkes
Living reference work entry

Abstract

A 25-year-old man presented with a 9-month history of headaches. CT and MRI/MRA revealed a giant, partially thrombosed aneurysm of the basilar artery bifurcation. The origins of both posterior cerebral arteries (PCA) and both superior cerebellar arteries (SCA) arose from the aneurysm sac, which developed from a diffuse enlargement of the basilar artery bifurcation and extended posteriorly. The attempt to catheterize the PCAs for a Y-stenting procedure failed. Access to the PCAs was not possible without crossing the aneurysm sac, which might have mobilized thrombus material from there downstream. In the first treatment session, two pCONus1 devices were implanted into the aneurysm sac in a crossing fashion. The stent petals defined a boundary between the aneurysm sac and the basilar artery bifurcation for the subsequent coil occlusion. Coil compaction required two additional treatment sessions. During the second procedure, the catheterization of the left PCA succeeded, and a Solitaire stent was deployed from there to the distal segment of the basilar artery trunk. The attempted access to the right PCA failed on the same day but was possible in the following third treatment session, which allowed the deployment of a second, crossing Solitaire stent from the right PCA to the trunk of the basilar artery. The reconstruction of the basilar artery bifurcation with two crossing pCONus1 devices and two crossing Solitaire stents allowed the complete and stable coil occlusion of the aneurysm sac. The entire aneurysm treatment was tolerated without a permanent neurological deficit. The combined use of multiple extra- and intrasaccular implants for the treatment of complex aneurysms is the main topic of this chapter.

Keywords

Basilar artery bifurcation Stent-assisted coil occlusion Crossing pCONus1 bifurcation stents Crossing Solitaire stents 

References

  1. Aguilar-Pérez M, Kurre W, Fischer S, Bäzner H, Henkes H. Coil occlusion of wide-neck bifurcation aneurysms assisted by a novel intra- to extra-aneurysmatic neck-bridging device (pCONus): initial experience. AJNR Am J Neuroradiol. 2014;35(5):965–71.  https://doi.org/10.3174/ajnr.A3807.CrossRefPubMedGoogle Scholar
  2. Bhogal P, Aguilar Pérez M, Martinez Moreno R, Miś M, Miś M, Henkes H. Combined use of a pCONus and a Solitaire stent: report of two cases. Interv Neuroradiol. 2017;23(2):123–8.  https://doi.org/10.1177/1591019916680571.CrossRefPubMedGoogle Scholar
  3. Clajus C, Sychra V, Strasilla C, Klisch J. Stent-assisted coil embolization of intracranial aneurysms using the Solitaire™ AB Neurovascular Remodeling Device: initial and midterm follow-up results. Neuroradiology. 2013;55(5):629–38.  https://doi.org/10.1007/s00234-013-1148-7.CrossRefPubMedGoogle Scholar
  4. Fischer S, Weber A, Titschert A, Brenke C, Kowoll A, Weber W. Single-center experience in the endovascular treatment of wide-necked intracranial aneurysms with a bridging intra−/extra-aneurysm implant (pCONus). J Neurointerv Surg. 2016;8(11):1186–91.  https://doi.org/10.1136/neurintsurg-2015-012004.CrossRefPubMedGoogle Scholar
  5. Gory B, Klisch J, Bonafé A, Mounayer C, Beaujeux R, Moret J, Lubicz B, Riva R, Turjman F. Solitaire AB stent-assisted coiling of wide-necked intracranial aneurysms: short-term results from a prospective, consecutive, European multicentric study. Neuroradiology. 2013;55(11):1373–8.  https://doi.org/10.1007/s00234-013-1277-z.CrossRefPubMedGoogle Scholar
  6. Gory B, Klisch J, Bonafé A, Mounayer C, Beaujeux R, Moret J, Lubicz B, Riva R, Turjman F. Solitaire AB stent-assisted coiling of wide-necked intracranial aneurysms: mid-term results from the SOLARE Study. Neurosurgery. 2014;75(3):215–9 ; discussion 219.  https://doi.org/10.1227/NEU.0000000000000415.CrossRefPubMedGoogle Scholar
  7. Gory B, Aguilar-Pérez M, Pomero E, Turjman F, Weber W, Fischer S, Henkes H, Biondi A. pCONus Device for the endovascular treatment of wide-neck middle cerebral artery aneurysms. AJNR Am J Neuroradiol. 2015;36(9):1735–40.  https://doi.org/10.3174/ajnr.A4392.CrossRefPubMedGoogle Scholar
  8. Gory B, Aguilar-Pérez M, Pomero E, Turjman F, Weber W, Fischer S, Henkes H, Biondi A. One-year angiographic results after pCONus stent-assisted coiling of 40 wide-neck middle cerebral artery aneurysms. Neurosurgery. 2017;80(6):925–33.  https://doi.org/10.1093/neuros/nyw131.CrossRefPubMedGoogle Scholar
  9. Guo XB, Yan BJ, Guan S. Waffle-cone technique using solitaire AB stent for endovascular treatment of complex and wide-necked bifurcation cerebral aneurysms. J Neuroimaging. 2014;24(6):599–602.  https://doi.org/10.1111/jon.12121.CrossRefPubMedGoogle Scholar
  10. Huded V, Nair RR, Vyas DD, Chauhan BN. Stent-assisted coiling of wide-necked intracranial aneurysms using the Solitaire AB stent. J Neurosci Rural Pract. 2014;5(3):254–7.  https://doi.org/10.4103/0976-3147.133577.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Jeong HW, Seung WB. Outcomes of stent-assisted coil embolization of wide-necked intracranial aneurysms using the Solitaire™ AB neurovascular remodeling device. J Cerebrovasc Endovasc Neurosurg. 2015;17(4):301–12.  https://doi.org/10.7461/jcen.2015.17.4.301.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Klisch J, Eger C, Sychra V, Strasilla C, Basche S, Weber J. Stent-assisted coil embolization of posterior circulation aneurysms using Solitaire ab: preliminary experience. Neurosurgery. 2009;65(2):258–66; discussion 266.  https://doi.org/10.1227/01.NEU.0000348295.44970.C8.CrossRefPubMedGoogle Scholar
  13. Klisch J, Clajus C, Sychra V, Eger C, Strasilla C, Rosahl S, Gerlach R, Bär I, Hoch H, Herbon U, Borota L, Jonasson P, Liebig T. Coil embolization of anterior circulation aneurysms supported by the Solitaire AB Neurovascular Remodeling Device. Neuroradiology. 2010;52(5):349–59.  https://doi.org/10.1007/s00234-009-0568-x.CrossRefPubMedGoogle Scholar
  14. Lee SY, Chae KS, Rho SJ, Choi HK, Park HS, Ghang CG. Clinical and angiographic outcomes of wide-necked aneurysms treated with the solitaire AB stent. J Cerebrovasc Endovasc Neurosurg. 2013;15(3):158–63.  https://doi.org/10.7461/jcen.2013.15.3.158.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Li TF, Shui SF, Han XW, Yan L, Ma J, Guo D, Zhu HC, Wang SK, He YH, Chen WW, Wei LP, Wang MK, Song TM. The use of solitaire AB stents in coil embolization of wide-necked cerebral aneurysms. PLoS One. 2015;10(10):e0139714.  https://doi.org/10.1371/journal.pone.0139714.CrossRefPubMedPubMedCentralGoogle Scholar
  16. Li XD, Qin J, Xiao ZY, Feng Y, Chen JK. Solitaire AB stent-assisted coiling of wide-neck micro aneurysms. J Korean Neurosurg Soc. 2016;59(4):341–5.  https://doi.org/10.3340/jkns.2016.59.4.341.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Liebig T, Henkes H, Reinartz J, Miloslavski E, Kühne D. A novel self-expanding fully retrievable intracranial stent (SOLO): experience in nine procedures of stent-assisted aneurysm coil occlusion. Neuroradiology. 2006;48(7):471–8.  https://doi.org/10.1007/s00234-006-0062-7.CrossRefPubMedGoogle Scholar
  18. Lubicz B, Collignon L, Raphaeli G, Bandeira A, Bruneau M, De Witte O. Solitaire stent for endovascular treatment of intracranial aneurysms: immediate and mid-term results in 15 patients with 17 aneurysms. J Neuroradiol. 2010;37(2):83–8.  https://doi.org/10.1016/j.neurad.2010.02.003.CrossRefPubMedGoogle Scholar
  19. Lubicz B, Morais R, Alghamdi F, Mine B, Collignon L, Eker OF. The pCONus device for the endovascular treatment of wide neck bifurcation aneurysms. J Neurointerv Surg. 2016;8(9):940–4.  https://doi.org/10.1136/neurintsurg-2015-011898.CrossRefPubMedGoogle Scholar
  20. Martínez-Galdámez M, Saura P, Saura J, Martínez A, De Campos JM, Pérez A. Y-stent-assisted coil embolization of anterior circulation aneurysms using two Solitaire AB devices: a single center experience. Interv Neuroradiol. 2012;18(2):158–63.  https://doi.org/10.1177/159101991201800206.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Mpotsaris A, Henkes H, Weber W. Waffle Y technique: pCONus for tandem bifurcation aneurysms of the middle cerebral artery. J Neurointerv Surg. 2014;6(10):e51.  https://doi.org/10.1136/neurintsurg-2013-010921.rep.CrossRefPubMedGoogle Scholar
  22. Nas OF, Kacar E, Kaya A, Erdogan C, Hakyemez B. Modified Y-configured stents with the waffle-cone technique by use of Solitaire® stent for patients with wide-necked bifurcation aneurysms. Jpn J Radiol. 2015a;33(8):503–8.  https://doi.org/10.1007/s11604-015-0454-x.CrossRefPubMedGoogle Scholar
  23. Nas OF, Kacar E, Kaya A, Erdogan C, Hakyemez B. Rare use of twin Solitaire® stents in the double waffle-cone technique for endovascular treatment of a wide-necked bifurcation aneurysm. Interv Neuroradiol. 2015b;21(2):167–70.  https://doi.org/10.1177/1591019915581998.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Park HR, Yoon SM, Shim JJ, Kim SH. Waffle-cone technique using solitaire AB stent. J Korean Neurosurg Soc. 2012;51(4):222–6.  https://doi.org/10.3340/jkns.2012.51.4.222.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Peach T, Cornhill JF, Nguyen A, Riina H, Ventikos Y. The ‘Sphere’: a dedicated bifurcation aneurysm flow-diverter device. Cardiovasc Eng Technol. 2014;5(4):334–47.  https://doi.org/10.1007/s13239-014-0188-4.CrossRefPubMedPubMedCentralGoogle Scholar
  26. Pérez MA, Bhogal P, Moreno RM, Wendl C, Bäzner H, Ganslandt O, Henkes H. Use of the pCONus as an adjunct to coil embolization of acutely ruptured aneurysms. J Neurointerv Surg. 2017;9(1):39–44.  https://doi.org/10.1136/neurintsurg-2016-012508.CrossRefPubMedGoogle Scholar
  27. Rahal JP, Dandamudi VS, Safain MG, Malek AM. Double waffle-cone technique using twin Solitaire detachable stents for treatment of an ultra-wide necked aneurysm. J Clin Neurosci. 2014;21(6):1019–23.  https://doi.org/10.1016/j.jocn.2013.08.029.CrossRefPubMedGoogle Scholar
  28. Sarabia R, Arrese I. Y-stent-assisted coil embolization of anterior circulation aneurysms using two solitaire AB devices: a single center experience. Interv Neuroradiol. 2012;18(4):490.  https://doi.org/10.1177/159101991201800416.CrossRefPubMedPubMedCentralGoogle Scholar
  29. Ulfert C, Pfaff J, Schönenberger S, Bösel J, Herweh C, Pham M, Bendszus M, Möhlenbruch M. The pCONus device in treatment of wide-necked aneurysms: technical and midterm clinical and angiographic results. Clin Neuroradiol. 2018;28(1):47–54.  https://doi.org/10.1007/s00062-016-0542-z.CrossRefPubMedGoogle Scholar
  30. Zhang J, Wang D, Li X. Solitaire AB stent-assisted coiling embolization for the treatment of ruptured very small intracranial aneurysms. Exp Ther Med. 2015;10(6):2239–44.  https://doi.org/10.3892/etm.2015.2826.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Marta Aguilar Pérez
    • 1
  • Muhammad AlMatter
    • 1
  • Hans Henkes
    • 1
  1. 1.Neuroradiologische KlinikNeurozentrum, Klinikum StuttgartStuttgartGermany

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