Treatment posterior circulation fusiform aneurysms using pipeline embolisation device

Find out how Dr Karashash Menlibayeva treated a 56-year-old female patient with posterior circulation fusiform aneurysms.

Case presentation

Patient

56-year-old female patient
Main complaint: right hemiparesis (motor examination grade 2/5)
History: infarction consistent with embolic aetiology 2 years ago
Examination: MRI and DSA
Diagnosis: unruptured right vertebral fusiform aneurysm (VFA) involving the basilar and the left vertebral artery

Figure 1, A and B: axial Т2 MR images demonstrating multiple small areas of infarction consistent with embolic etiology.

3D CT angiography reconstruction shows a VFA involving the left vertebral artery and the basilar artery. A lateral aneurysm originating from the basilar artery is seen. Microaneurysm in P1 segment of the right PCA.

Anteroposterior and lateral DSA demonstrates lateral basilar artery aneurysm.

The patient received oral aspirin (300 mg) and Ticagrelor (180 mg) 4 hours before surgery, and 5000 U of heparin was used during surgery.

The patient was treated with PEDs (4 × 25 mm).

Left vertebral artery occluded by coiling above PICA.

Right VA

Left VA

Follow-up at 3 months DSA demonstrates complete occlusion of the VFA.

Follow-up after 12 months. DSA from right vertebral artery.

Follow-up after 12 months. DSA from left vertebral artery.

Conclusions

Microsurgical treatment of VFAs can be difficult and associated with high rates of morbidity and mortality.
Treatment with the pipeline embolization device may provide an effective and less invasive alternative to microsurgical intervention.

Treatment of posterior circulation fusiform aneurysms using the pipeline embolisation device