Intravascular stent and endovascular coil placement for a ruptured fusiform aneurysm of the basilar artery

Case report and review of the literature

Randall T. HigashidaDepartments of Radiology and Neurological Surgery, Division of Interventional Neuroradiology, and Department of Neurology, University of California, San Francisco Medical Center, San Francisco, California

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Wade SmithDepartments of Radiology and Neurological Surgery, Division of Interventional Neuroradiology, and Department of Neurology, University of California, San Francisco Medical Center, San Francisco, California

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Daryl GressDepartments of Radiology and Neurological Surgery, Division of Interventional Neuroradiology, and Department of Neurology, University of California, San Francisco Medical Center, San Francisco, California

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Ross UrwinDepartments of Radiology and Neurological Surgery, Division of Interventional Neuroradiology, and Department of Neurology, University of California, San Francisco Medical Center, San Francisco, California

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Christopher F. DowdDepartments of Radiology and Neurological Surgery, Division of Interventional Neuroradiology, and Department of Neurology, University of California, San Francisco Medical Center, San Francisco, California

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Peter A. BalousekDepartments of Radiology and Neurological Surgery, Division of Interventional Neuroradiology, and Department of Neurology, University of California, San Francisco Medical Center, San Francisco, California

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Van V. HalbachDepartments of Radiology and Neurological Surgery, Division of Interventional Neuroradiology, and Department of Neurology, University of California, San Francisco Medical Center, San Francisco, California

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Page Range:
944–949
Volume/Issue:
Volume 87: Issue 6
DOI link:
https://doi.org/10.3171/jns.1997.87.6.0944
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✓ The authors demonstrate the technical feasibility of using intravascular stents in conjunction with electrolytically detachable coils (Guglielmi detachable coils [GDCs]) for treatment of fusiform, broad-based, acutely ruptured intracranial aneurysms and review the literature on endovascular approaches to ruptured aneurysms and cerebral stent placement. A 77-year-old man presented with an acute subarachnoid hemorrhage of the posterior fossa. A fusiform aneurysm with a broad-based neck measuring 12 mm and involving the distal vertebral artery (VA) and proximal third of the basilar artery (BA) was demonstrated on cerebral angiography. The aneurysm was judged to be inoperable. Six days later a repeated hemorrhage occurred. A 15-mm-long intravascular stent was placed across the base of the aneurysm in the BA and expanded to 4 mm to act as a bridging scaffold to create a neck. A microcatheter was then guided through the interstices of the stent into the body and dome of the aneurysm, and GDCs were deposited for occlusion.

The arteriogram obtained after stent placement demonstrated occlusion of the main dome and body of the aneurysm. The coils were stably positioned and held in place by the stent across the distal VA and BA fusiform aneurysm. Excellent blood flow to the distal BA and posterior cerebral artery was maintained through the stent. There were no new brainstem ischemic events attributable to the procedure. No rebleeding from the aneurysm had occurred by the 10.5-month follow-up evaluation, and the patient has experienced significant neurological improvement.

Certain types of intracranial fusiform aneurysms may now be treated by combining intravascular stent and GDC placement for aneurysm occlusion via an endovascular approach. This is the first known clinical application of this novel approach in a ruptured cerebral aneurysm.

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Contributor Notes

Address reprint requests to: Randall T. Higashida, M.D., Departments of Radiology and Neurological Surgery, Division of Interventional Neuroradiology, University of California San Francisco Medical Center, 505 Parnassus Avenue, L-352, San Francisco, California 94143–0628.
  • 1.

    Berenstein A, , Ransohoff J, & Kupersmith M, et al: Transvascular treatment of giant aneurysms of the cavernous carotid and vertebral arteries. Functional investigation and embolization. Surg Neurol 21:3–12, 1984 Berenstein A, Ransohoff J, Kupersmith M, et al: Transvascular treatment of giant aneurysms of the cavernous carotid and vertebral arteries. Functional investigation and embolization. Surg Neurol 21:3–12, 1984

    • Search Google Scholar
    • Export Citation
  • 2.

    Chyatte D, , Fode NC, & Sundt TM Jr: Early versus late intracranial aneurysm surgery in subarachnoid hemorrhage. J Neurosurg 69:326–331, 1988 Chyatte D, Fode NC, Sundt TM Jr: Early versus late intracranial aneurysm surgery in subarachnoid hemorrhage. J Neurosurg 69:326–331, 1988

    • Search Google Scholar
    • Export Citation
  • 3.

    Fox AJ, , Viñuela F, & Pelz DM, et al: Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms. J Neurosurg 66:40–46, 1987 Fox AJ, Viñuela F, Pelz DM, et al: Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms. J Neurosurg 66:40–46, 1987

    • Search Google Scholar
    • Export Citation
  • 4.

    Geremia G, , Bakon M, & Brennecke L, et al: Experimental arteriovenous fistulas: treatment with porous metallic stents. AJNR 16:1965–1973, 1995 Geremia G, Bakon M, Brennecke L, et al: Experimental arteriovenous fistulas: treatment with porous metallic stents. AJNR 16:1965–1973, 1995

    • Search Google Scholar
    • Export Citation
  • 5.

    Geremia G, , Bakon M, & Brennecke L, et al: Experimental arteriovenous fistulas: treatment with silicone-covered metallic stents. AJNR 18:271–277, 1997 Geremia G, Bakon M, Brennecke L, et al: Experimental arteriovenous fistulas: treatment with silicone-covered metallic stents. AJNR 18:271–277, 1997

    • Search Google Scholar
    • Export Citation
  • 6.

    Guglielmi G, , Viñuela F, & Duckwiler G, et al: Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg 7:515–524, 1992 Guglielmi G, Viñuela F, Duckwiler G, et al: Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg 7:515–524, 1992

    • Search Google Scholar
    • Export Citation
  • 7.

    Higashida RT, , Halbach VV, & Cahan LD, et al: Detachable balloon embolization therapy of posterior circulation intracranial aneurysms. J Neurosurg 71:512–519, 1989 Higashida RT, Halbach VV, Cahan LD, et al: Detachable balloon embolization therapy of posterior circulation intracranial aneurysms. J Neurosurg 71:512–519, 1989

    • Search Google Scholar
    • Export Citation
  • 8.

    Higashida RT, , Halbach VV, & Cahan LD, et al: Transluminal angioplasty for treatment of intracranial arterial vasospasm. J Neurosurg 71:648–653, 1989 Higashida RT, Halbach VV, Cahan LD, et al: Transluminal angioplasty for treatment of intracranial arterial vasospasm. J Neurosurg 71:648–653, 1989

    • Search Google Scholar
    • Export Citation
  • 9.

    Higashida RT, , Halbach VV, & Dowd CF, et al: Endovascular surgical approach to intracranial vascular diseases. J Endovasc Surg 3:146–157, 1996 Higashida RT, Halbach VV, Dowd CF, et al: Endovascular surgical approach to intracranial vascular diseases. J Endovasc Surg 3:146–157, 1996

    • Search Google Scholar
    • Export Citation
  • 10.

    Higashida RT, , Halbach VV, & Dowd CF, et al: Interventional neurovascular treatment for giant aneurysms of the posterior circulation. J Surg Cereb Stroke 21:401–406, 1993 Higashida RT, Halbach VV, Dowd CF, et al: Interventional neurovascular treatment for giant aneurysms of the posterior circulation. J Surg Cereb Stroke 21:401–406, 1993

    • Search Google Scholar
    • Export Citation
  • 11.

    Higashida RT, , Tsai FY, & Halbach VV, et al: Transluminal angioplasty, thrombolysis, and stenting for extracranial and intracranial cerebral vascular disease. J Intervent Cardiol 9:245–255, 1996 Higashida RT, Tsai FY, Halbach VV, et al: Transluminal angioplasty, thrombolysis, and stenting for extracranial and intracranial cerebral vascular disease. J Intervent Cardiol 9:245–255, 1996

    • Search Google Scholar
    • Export Citation
  • 12.

    Jane JA, , Winn HR, & Richardson AE: The natural history of intracranial aneurysms: rebleeding rates during the acute and long term period and implication for surgical management. Clin Neurosurg 24:176–184, 1977 Jane JA, Winn HR, Richardson AE: The natural history of intracranial aneurysms: rebleeding rates during the acute and long term period and implication for surgical management. Clin Neurosurg 24:176–184, 1977

    • Search Google Scholar
    • Export Citation
  • 13.

    Juvela S: Rebleeding from ruptured intracranial aneurysms. Surg Neurol 32:323–326, 1989 Juvela S: Rebleeding from ruptured intracranial aneurysms. Surg Neurol 32:323–326, 1989

    • Search Google Scholar
    • Export Citation
  • 14.

    Kassell NF, & Torner JC: Aneurysmal rebleeding: a preliminary report from the Cooperative Aneurysm Study. Neurosurgery 13:479–481, 1983 Kassell NF, Torner JC: Aneurysmal rebleeding: a preliminary report from the Cooperative Aneurysm Study. Neurosurgery 13:479–481, 1983

    • Search Google Scholar
    • Export Citation
  • 15.

    Liermann D, , Strecker EP, & Peters J: The Strecker stent: indications and results in iliac and femoropopliteal arteries. Cardiovasc Intervent Radiol 15:298–305, 1992 Liermann D, Strecker EP, Peters J: The Strecker stent: indications and results in iliac and femoropopliteal arteries. Cardiovasc Intervent Radiol 15:298–305, 1992

    • Search Google Scholar
    • Export Citation
  • 16.

    Ljunggren B, , Brandt L, & Saveland H, et al: Management of ruptured intracranial aneurysms: a review. Br J Neurosurg 1:9–32, 1987 Ljunggren B, Brandt L, Saveland H, et al: Management of ruptured intracranial aneurysms: a review. Br J Neurosurg 1:9–32, 1987

    • Search Google Scholar
    • Export Citation
  • 17.

    Massoud TF, , Turjman F, & Ji C, et al: Endovascular treatment of fusiform aneurysms with stents and coils: technical feasibility in a swine model. AJNR 16:1953–1963, 1995 Massoud TF, Turjman F, Ji C, et al: Endovascular treatment of fusiform aneurysms with stents and coils: technical feasibility in a swine model. AJNR 16:1953–1963, 1995

    • Search Google Scholar
    • Export Citation
  • 18.

    McDougall CG, , Halbach VV, & Dowd CF, et al: Endovascular treatment of basilar tip aneurysms using electrolytically detachable coils. J Neurosurg 84:393–399, 1996 McDougall CG, Halbach VV, Dowd CF, et al: Endovascular treatment of basilar tip aneurysms using electrolytically detachable coils. J Neurosurg 84:393–399, 1996

    • Search Google Scholar
    • Export Citation
  • 19.

    Palmaz JC: Intravascular stenting: from basic research to clinical application. Cardiovasc Intervent Radiol 15:279–284, 1992 Palmaz JC: Intravascular stenting: from basic research to clinical application. Cardiovasc Intervent Radiol 15:279–284, 1992

    • Search Google Scholar
    • Export Citation
  • 20.

    Rosenørn J, , Eskesen V, & Schmidt K, et al: The risk of rebleeding from ruptured intracranial aneurysms. J Neurosurg 67:329–332, 1987 Rosenørn J, Eskesen V, Schmidt K, et al: The risk of rebleeding from ruptured intracranial aneurysms. J Neurosurg 67:329–332, 1987

    • Search Google Scholar
    • Export Citation
  • 21.

    Sundt TM Jr: Cerebral vasospasm following subarachnoid hemorrhage: evolution, management and relationship to timing of surgery. Clin Neurosurg 24:228–239, 1977 Sundt TM Jr: Cerebral vasospasm following subarachnoid hemorrhage: evolution, management and relationship to timing of surgery. Clin Neurosurg 24:228–239, 1977

    • Search Google Scholar
    • Export Citation
  • 22.

    Szikora I, , Guterman LR, & Wells KM, et al: Combined use of stents and coils to treat experimental wide-necked carotid aneurysms: preliminary results. AJNR 15:1091–1102, 1994 Szikora I, Guterman LR, Wells KM, et al: Combined use of stents and coils to treat experimental wide-necked carotid aneurysms: preliminary results. AJNR 15:1091–1102, 1994

    • Search Google Scholar
    • Export Citation
  • 23.

    Teitelbaum GP, , Halbach VV, & Larsen DW, et al: Treatment of massive posterior epistaxis by detachable coil embolization of a cavernous internal carotid artery aneurysm. Neuroradiology 37:334–336, 1995 Teitelbaum GP, Halbach VV, Larsen DW, et al: Treatment of massive posterior epistaxis by detachable coil embolization of a cavernous internal carotid artery aneurysm. Neuroradiology 37:334–336, 1995

    • Search Google Scholar
    • Export Citation
  • 24.

    Tettenborn D, & Dycka J: Prevention and treatment of delayed ischemic dysfunction in patients with aneurysmal subarachnoid hemorrhage. Stroke 21 (Suppl 4):85–89, 1990 Tettenborn D, Dycka J: Prevention and treatment of delayed ischemic dysfunction in patients with aneurysmal subarachnoid hemorrhage. Stroke 21 (Suppl 4):85–89, 1990

    • Search Google Scholar
    • Export Citation
  • 25.

    Viñuela F, , Duckwiler G, & Mawad M: Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86:475–482, 1997 Viñuela F, Duckwiler G, Mawad M: Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86:475–482, 1997

    • Search Google Scholar
    • Export Citation
  • 26.

    Wakhloo AK, , Tio FO, & Lieber BB, et al: Self-expanding nitinol stents in canine vertebral arteries: hemodynamics and tissue response. AJNR 16:1043–1051, 1995 Wakhloo AK, Tio FO, Lieber BB, et al: Self-expanding nitinol stents in canine vertebral arteries: hemodynamics and tissue response. AJNR 16:1043–1051, 1995

    • Search Google Scholar
    • Export Citation

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