Embolization of Ruptured Aneurysm Arising From Basilar Artery Fenestration Using Hydrocoils

Karuna Tamrakar,Duan Chuan Zhi

doi:10.7759/cureus.326

Abstract

Aneurysms arising from the basilar artery fenestration are considered among the rare cerebrovascular diseases. Here, we report on a 44-year-old gentleman who presented with the sudden onset of severe headache complicated by several episodes of vomiting and an altered level of consciousness. A subarachnoid hemorrhage in the interpeduncle and ambient cisterns was detected by computed tomography of the head. During left vertebral arteriography, a basilar fenestration with a ruptured aneurysm just above the proximal end of vertebrobasilar junction was identified. The aneurysm was successfully occluded by means of endovascular treatment using Hydrosoft coils. In the 15-month follow-up angiography, 100% occlusion without recurrence and recanalization was observed. Bilateral anterior inferior cerebellar arteries and both channels of the basilar artery fenestration were entirely filled in follow-up angiograms.

Highlights

Authors have reported the soft hydrocoil as an effective embolic material to provide durable and progressive angiographic occlusion [1]
We describe a case of a ruptured aneurysm of basilar artery (BA) fenestration that was successfully occluded by the soft type of volume expansile coils, preserving the fenestrated segments and side branches
anterior inferior cerebellar arteries (AICA) are originating from fenestrated limbs bilaterally, C: Immediate post-embolization vertebral angiography: Near complete occlusion of an aneurysm after HydroSoft coils being positioned as finishing coils, D: 15-month follow-up angiography showing complete and stable occlusion of the aneurysm sparing the side branches

Summary

Introduction

Authors have reported the soft hydrocoil as an effective embolic material to provide durable and progressive angiographic occlusion [1]. In the selective left vertebral arteriography, a basilar fenestration was demonstrated just above the vertebrobasilar junction (Figure 1A), and a 4 mm x 5 mm-sized ruptured aneurysm was seen arising from the proximal end of the fenestration. In the immediate post-embolization angiography, the aneurysm was near completely occluded and bilaterally AICA and fenestrated limbs of the BA were exclusively visualized (Figure 1C). AICA are originating from fenestrated limbs bilaterally (arrows), C: Immediate post-embolization vertebral angiography: Near complete occlusion of an aneurysm after HydroSoft coils being positioned as finishing coils (arrow), D: 15-month follow-up angiography showing complete and stable occlusion of the aneurysm sparing the side branches

Discussion

Conclusions

Disclosures

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