A Case of Wide Necked Basilar Tip Aneurysm Treated with Horizontal Stent-assisted Coil Embolization

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Objectives: We report our experience with a patient undergoing horizontal stent-assisted coil embolization for an aneurysm of the basilar tip, in which favorable coil embolization was achieved through innovative approaches that enhanced our intraoperative working views.Case Presentation: A 50-year-old woman was referred to our institution for further evaluation and treatment of an unruptured basilar tip aneurysm which had been diagnosed by magnetic resonance angiography (MRA). A cerebral angiogram showed a wide-necked saccular aneurysm (7.2-mm diameter/6.8-mm neck length), and bilateral posterior cerebral arteries (PCAs) arising directly from the aneurysmal neck. A right internal carotid artery (ICA) angiograms revealed a relatively developed right posterior communicating artery (PcomA) (1.1-mm diameter), and there was neither severe vascular bending nor tortuosity in the areas encompassing the right PcomA and the left P1 and P2 of PCA. We performed horizontal stent-assisted coil embolization via the right PcomA, because horizontal stent-assisted coil embolization was possible to perform anatomically and was considered safer and simpler than other adjunctive techniques. Simultaneous internal carotid-vertebral angiograms allowed stent delivery systems to be navigated from the right ICA to the left PCA via the right PcomA using fewer steps.Conclusions: If the anatomy would be favorable, horizontal stent-assisted coil embolization could be considered as an alternative method, in the case of other adjunctive techniques being difficult to perform for a wide-necked basilar tip aneurysm. Innovative approaches designed to enhance an appropriate intraoperative working view would facilitate performing horizontal stent-assisted coil embolization.