Rapidly growing basilar dissecting aneurysm

A 58-year-woman was admitted in poor clinical condition (Hunt and Hess grade V) after subarachnoid and intraventricular haemorrhage. She was intubated, and hydrocephalus was treated with ventricular drainage. Angiography on day 3 showed a small dissecting aneurysm of the distal basilar artery (fig 1A). Treatment was judged not possible. She had a recurrent haemorrhage on day 14, and a second angiography on day 23 revealed that the size of the aneurysm had increased (fig 1B). At that time, it was decided to treat the aneurysm with stent-assisted coiling. Angiography at the time of treatment on day 30 showed that the aneurysm had enlarged again (fig 1C). A stent was placed in the basilar artery and right posterior cerebral artery covering the neck of the aneurysm, and the aneurysm was occluded with coils through the mazes of the stent. Follow-up angiography 6 months later showed stable complete occlusion of the aneurysm (fig 1D, arrows point to proximal and distal stent markers; the stent itself is invisible). The patient’s clinical condition had improved markedly with only some cognitive impairment and memory disturbances.

Figure 1. (A) Angiography 3 days after a subarachnoid and intraventricular haemorrhage, showing a small dissecting aneurysm of the distal basilar artery; (B) angiography on day 23 showing an increase in size of the aneurysm; (C) angiography on day 30 showing a further increase in size; (D) follow-up angiography 6 months after stent-assisted coiling, showing stable complete occlusion of the aneurysm (arrows indicate proximal and distal stent markers).