Transcirculation balloon-assisted stent-supported coil embolization of a basilar tip aneurysm

Vijay Agarwal, M.D.,1 Ali Zomorodi, M.D.,1 Cameron Mcdougal, M.D.,2 Ranjith Babu, M.D.,1 Adam Back, M.D.,1 and L. Fernando Gonzalez, M.D.1

1Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina; and 2Barrow Neurological Institute, Phoenix, Arizona

We present the case of a balloon-assisted, stent-supported coil embolization of a basilar tip aneurysm. Initially, a balloon extending from the basilar artery into the right PCA was placed.3 However, even with a more proximal purchase, coils were found to impinge on the left PCA. Subsequently, a transcirculation approach was performed, where the left posterior communicating artery was utilized as a conduit for balloon support and the coils were embolized from the ipsilateral vertebral artery.1 However, after this transcirculation approach was completed, there was a coil tail extruding from the aneurysm. The balloon was then removed over an exchange wire and a horizontal stent advanced, spanning the entire neck of the aneurysm, eliminating the extruded coil.2

1. Albuquerque FC, Gonzalez LF, Hu YC, et al: Transcirculation endovascular treatment of complex cerebral aneurysms: technical considerations and preliminary results. Neurosurgery 68:820--829, 2011
2. Chalouhi N, Jabbour P, Gonzalez LF, et al: Safety and efficacy of endovascular treatment of basilar tip aneurysms by coiling with and without stent assistance: a review of 235 cases. Neurosurgery 71:785--794, 2012
3. Chalouhi N, Starke RM, Koltz MT, et al: Stent-assisted coiling versus balloon remodeling of wide-neck aneurysms: comparison of angiographic outcomes. AJNR Am J Neuroradiol 10:1987--1992, 2013

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