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. 2020 Aug 3;88(1):82–95. doi: 10.1093/neuros/nyaa317

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© Congress of Neurological Surgeons 2020.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

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FIGURE 9. — Imaging studies of another case of remote proximal parent artery occlusion (RPO) (endovascular coil embolization of bilateral vertebral arteries) without bypass. A 23-yr-old man presented with brainstem compression syndrome caused by giant fusiform and dolichoectatic aneurysms of the basilar trunk (BT-GFDA). A, Preoperative angiogram demonstrated BT-GFDA. B, Postoperative right carotid artery angiogram demonstrated sufficient collateral flow from the right posterior communicating artery (Pcom). Coils are shown in arrows. C, Evolution of collateral flow from the right occipital artery to the vertebral artery as well as to the mid-basilar artery through the muscular branches was noted in the postoperative angiogram. T2-weighted MR images 24 d D, 3 mo E, and 12 mo F after RPO showed consecutive shrinkage and disappearance of the BT-GFDA. The patient has remained free from neurological deficits for 147 mo.