脳底動脈本幹部破裂動脈瘤に対する急性期コイル塞栓術

抄録

Basilar artery trunk aneurysm (BATA) is an aneurysm that occurs between the union of the bilateral vertebral arteries and the superior cerebellar artery. Dissection, in addition to the formation of an aneurysm itself, has been considered a cause of BATA. Direct surgery is difficult in many cases; however, recently, endovascular treatment (EVT) has been used for BATA rupture.
Between November 2007 and October 2015, acute-phase EVT was performed in five cases of ruptured BATA in our hospital. The male-to-female ratio and mean age of the patients were 1:4 and 63.6 years, respectively. The mean (range) maximum diameter of the aneurysm was 9.24 mm (3.2-17.8 mm). Four aneurysms were multilocular and irregular in shape, while two were partially thrombosed. During EVT, the balloon remodeling technique was used in four cases and a stent was used in one case as an adjunctive technique. We encountered two technical problems, namely failure during the delivery of the stent system and in-stent thrombosis. Three cases were exacerbated during the perioperative period and resulted in a modified Rankin score of 6.
In our cases, EVT did not contribute adequately to improving the prognosis of BATA. This study suggests that to perform coil embolization safely and effectively for ruptured BATA, establishing not only the appropriate procedural strategies, including perioperative antiplatelet drugs management, but also a treatment plan that considers disease severity and systemic condition is important.