Eleven-Year Follow-Up of a Ruptured Basilar Artery Trunk Dissecting Aneurysm Treated with Coiling and Multiple Overlapping Stents

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Objective: Ruptured dissecting aneurysm of the basilar artery trunk is a rare condition associated with high morbidity and mortality. Due to limited data, definitive treatment options and long-term radiological outcomes remain unclear. This report presents the 11-year radiographic follow-up of a dissecting basilar artery trunk aneurysm that presented with severe subarachnoid hemorrhage (SAH) and was managed with 4 endovascular interventions, including coiling and overlapping Enterprise Vascular Reconstruction Device (Johnson & Johnson, Miami, FL, USA) stent placements.

Case Presentation: A 32-year-old male with World Federation of Neurosurgical Surgeons Grade V SAH was transferred to our institution for the treatment of a 4-mm sidewall aneurysm of the basilar artery trunk. The lesion was initially managed on Day 1 with balloon-assisted coiling using a double microcatheter technique, achieving satisfactory occlusion. However, progressive aneurysm enlargement necessitated a 2nd intervention on Day 14, during which additional coils were deployed and 2 overlapping stents were placed. As the aneurysm continued to expand, reaching 10 mm by Day 32, a 3rd coiling procedure was performed. A 4th intervention—entailing further coiling and the placement of 2 additional overlapping stents—was completed 4 months following the initial event. The patient recovered without neurological deficits. During an 11-year follow-up, which included annual MRA and a 5-year interval DSA, a small residual at the aneurysm base detected at the 5-year follow-up demonstrated a gradual increase in size by 1.0 mm over 6 years. Despite this growth, the patient remained clinically stable.

Conclusion: Sustained prevention of re-rupture in a basilar artery trunk dissecting aneurysm was achieved through multiple overlapping stents combined with coil embolization, although aneurysm recurrence was not entirely controlled. Further investigation into more definitive therapies—such as flow-diverting devices—is warranted to achieve durable, curative outcomes.