Overlapping Stent-assisted Coil Embolization for Ruptured Blood Blister-like Aneurysms of Basilar Trunk: Two Case Reports

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Objective: In this report, we discuss the cases of two patients with a ruptured blood blister-like aneurysm (BBA) of the basilar trunk, who we treated with overlapping stent-assisted coil embolization (SACE).

Case Presentation: Case 1: The first patient was a 52-year-old male with a World Federation of Neurosurgical Societies (WFNS) Grade IV subarachnoid hemorrhage (SAH). A 2 mm anterior wall BBA of the basilar artery (BA) was detected on cerebral angiography on day 10 and treated with overlapping SACE. No recanalization was observed at 12 months after surgery. Case 2: The second patient was a 62-year-old female with WFNS Grade I SAH. A 1.7 mm posterior wall BBA of the BA was detected on cerebral angiography on day 5, which was treated with overlapping stents alone, but a residual aneurysm was noted on day 14, and SACE was additionally performed. Infarction of the perforating branch was noted after surgery, but the aneurysm was completely occluded on follow-up after 1 week. No recanalization was observed at 10 months after surgery.

Conclusion: Although overlapping SACE may be effective for ruptured BBAs of the basilar trunk, attention should be paid to the damage of the perforating branch after surgery in cases of aneurysm of the posterior wall of the BA. For appropriate multiple overlapping stents, accumulation of cases and further investigations are necessary.