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57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

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Horizontal stent placement plus coiling in broad based basilar-tip aneurysms: a new approach

Horizontale Stent-Applikation und Coiling von breitbasigen Basilaris-Kopf-Aneurysmen: ein neuer Weg

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  • corresponding author I. Wanke - Institute of Diagnostic and Interventional Radiology and Neuroradiology, University of Essen
  • E. Gizewski - Institute of Diagnostic and Interventional Radiology and Neuroradiology, University of Essen
  • P. Mummel - Dept. of Neurology, University of Essen
  • J. Regel - Dept. of Neurosurgery, University of Essen
  • M. Forsting - Institute of Diagnostic and Interventional Radiology and Neuroradiology, University of Essen

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocP 09.142

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc359.shtml

Published: May 8, 2006

© 2006 Wanke et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

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Objective: Basilar tip aneurysms represent the most frequent type of aneurysms in the posterior circulation. Specifically if wide-necked they remain a significant therapeutic challenge. The main surgical risks are the thalamoperforator vessels and the encroachment of the PCAs with clip placement. On the endovascular side stents may help to overcome many of these technical challenges. However, if both P1-segments are encroached into the aneurysm neck, sometimes stent placement from the mid of the basilar artery to one P1-segment is not enough. The Y-stent technique, with one stent passing through the interstices of another stent in a Y-configuration and thus remodelling the basilar tip is done in some cases. However, this is clearly not an optimal technique due to the mechanical forces to both stents and due to the increased thromboembolic risk.

Method and results:We describe two patients with a broad-based basilar tip aneurysm and very tortuous resp. hypoplastic vertebral artery which did not allow using the vertebrobasilar system as the antegrade way to reach the aneurysm. Because of the well-known high surgical risk we decided to navigate the stent through the internal carotid artery and via the posterior communicating artery into the contralateral P1-segment. We placed the stent in a horizontal manner infront of the aneurysm from one P1 segment to the contralateral one and filled the aneurysms subsequently with coils. Complete occlusion was achieved in both cases.

Conclusions: Horizontal stent placement in borad based basilar tip aneurysms is an alternative option if antegrade route is not feasible.