ORIGINAL RESEARCH INTERVENTIONAL Reconstructive Endovascular Treatment of Fusiform and Dissecting Basilar

BACKGROUND AND PURPOSE: Patients with fusiform basilar trunk aneurysms have a poor prognosis. Reconstructive endovascular therapy is possiblewithmodern devices.Wedescribe the clinical presentation, radiologic features, and clinical outcomeof 13 patientswith fusiform basilar trunk aneurysms treated with flow diverters, stents, and coils. MATERIALS ANDMETHODS: Of the 13 patients, 7 were men and 6 were women with a mean age of 59.7 years. Clinical presentation was SAH in 3 patients, mass effect on the brain stem in 4 patients, vertebral artery dissection in 1 patient, and the aneurysm was an incidental finding in 5 patients.Mean aneurysm sizewas 21mm. All except 1 were large or giant aneurysms. Nine aneurysmswere partially thrombosed. RESULTS: Stents were used in all 13 patients, in 2 patients with additional flowdiverters and in 11 patients with additional coils. In 4 patients, 1 vertebral artery was subsequently occluded with coils to decrease flow into the aneurysm. Of 13 patients, 9 had a good outcome with adequate aneurysm occlusion and stable size on follow-up of 6–72 months. One of 3 patients who presented with SAH died of a rebleed 1 month later. One other patient died soon after treatment of in-stent thrombosis, and another patient became mute after treatment. In 2 of 3 patients who presented with symptoms of mass effect, there was improvement at a follow-up of 6–24 months. CONCLUSIONS: Reconstructive endovascular therapy of fusiform and dissecting basilar trunk aneurysms is feasible but carries substan-tial risks. The safety and effectiveness in relation to natural history has not yet been elucidated. ABBREVIATIONS: 3DRA 3D rotational angiography; GOS Glasgow Outcome Scor