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Elek A, Cınar C, Küsbeci M, Oran I. Successful treatment of a basilar artery fenestration aneurysm using a kissing flow diverter stent. Br J Hosp Med (Lond) 2024; 85:1-3. [PMID: 38557091 DOI: 10.12968/hmed.2023.0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Alperen Elek
- Faculty of Medicine, Ege University, Izmir, Turkey
| | - Celal Cınar
- Department of Interventional Radiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Mahmut Küsbeci
- Department of Interventional Radiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ismail Oran
- Department of Interventional Radiology, Faculty of Medicine, Ege University, Izmir, Turkey
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Nayak MK, Sahoo B, Mahajan A, Naik S, Deep (Bag) N, Mishra B, Dash C. Reverse Y stenting in the management of vertebrobasilar junction fenestrated aneurysm: A novel technique. J Neurosci Rural Pract 2024; 15:126-129. [PMID: 38476428 PMCID: PMC10927056 DOI: 10.25259/jnrp_423_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/07/2023] [Indexed: 03/14/2024] Open
Abstract
Fenestrated aneurysm at vertebrobasilar junction (VBJ) is very rare and can occur due to non-fusion of longitudinal neural axis forming basilar artery in the early stage of embryonic life. Due to defects in tunica media and weakness in its wall, these fenestrations are more likely to develop an aneurysm. Various treatment strategies are required for the management of these types of aneurysms including simple coiling, stent-assisted coiling, balloon remodeling technique, and more recently kissing flow diverters. Herein, we report the case of ruptured fenestrated VBJ aneurysm which was managed successfully with novel reverse Y stenting with coiling.
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Affiliation(s)
- Manoj Kumar Nayak
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Biswajit Sahoo
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Anshu Mahajan
- Department of Interventional Neuroradiology, Medanta The Medicity, Gurgaon, Haryana, India
| | - Suprava Naik
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Nerbadyswari Deep (Bag)
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Biswamohan Mishra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Chinmaya Dash
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Miyata H, Ninomiya F, Fujita T, Nonoyama Y, Nakazawa T, Fukao S. A Case of Horizontal Stent-assisted Coiling for an Aneurysm Arising from Fenestration of the Vertebral Artery: A Technical Case Report. Neurol Med Chir (Tokyo) 2023. [PMID: 37005245 DOI: 10.2176/jns-nmc.2022-0309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Horizontal stenting protects the aneurysm neck with stent deployment across the aneurysm neck via the circle of Willis. A saccular aneurysm associated with intracranial arterial fenestration is very rare. Herein, we describe the first case of an unruptured aneurysm related to intracranial arterial fenestration treated with horizontal stenting. A 23-year-old woman presented with a 7-mm broad-necked aneurysm at the fenestration of the right intracranial vertebral artery (VA), which was incidentally found on magnetic resonance imaging. The patient underwent endovascular treatment with horizontal stenting via the vertebrobasilar junction from the contralateral left VA, followed by coil embolization using a jailed microcatheter from the ipsilateral right VA. The procedure was finished with sufficient embolization, and no complications occurred. Horizontal stent delivery via the vertebrobasilar junction for coil embolization of a broad-necked aneurysm arising from the fenestration of the VA is a safe and effective therapeutic strategy.
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Affiliation(s)
- Haruka Miyata
- Department of Neurosurgery, Kyoto Okamoto Memorial Hospital
| | - Futa Ninomiya
- Department of Neurosurgery, Kyoto Okamoto Memorial Hospital
| | - Tomoaki Fujita
- Department of Neurosurgery, Kyoto Okamoto Memorial Hospital
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Scullen T, Mathkour M, Dumont A, Glennon S, Wang A. Intracranial Aneurysms in the Context of Variant Cerebrovascular Anatomy: A Review of the Literature. World Neurosurg 2022; 165:58-68. [PMID: 35659590 DOI: 10.1016/j.wneu.2022.05.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/27/2022] [Accepted: 05/29/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Tyler Scullen
- Tulane University School of Medicine, Tulane University, New Orleans, LA 70130; Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121
| | - Mansour Mathkour
- Tulane University School of Medicine, Tulane University, New Orleans, LA 70130; Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121
| | - Aaron Dumont
- Tulane University School of Medicine, Tulane University, New Orleans, LA 70130
| | - Stephen Glennon
- Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121
| | - Arthur Wang
- Tulane University School of Medicine, Tulane University, New Orleans, LA 70130
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Styczen H, Fischer S, Gawlitza M, Meyer L, Goertz L, Maurer C, Alexandrou M, Khanafer A, Lobsien D, Deuschl C, Klisch J, Kabbasch C, Fiehler J, Berlis A, Papanagiotou P, Henkes H, Maus V. Reconstructive endovascular treatment of basilar artery fenestration aneurysms: A multi-centre experience and literature review. Neuroradiol J 2021; 35:319-328. [PMID: 34476993 DOI: 10.1177/19714009211042877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Data on outcome after endovascular treatment of basilar artery fenestration aneurysms (BAFAs) is limited. This study presents our multi-centre experience of BAFAs treated by different reconstructive techniques including coils, stent-assisted coiling (SAC), flow diversion and intra-saccular flow disruption with the Woven Endobridge (WEB). METHODS Retrospective analysis of 38 BAFAs treated endovascularly between 2003 and 2020. The primary endpoint was complete aneurysm obliteration defined as Raymond-Roy occlusion classification (RROC) I on immediate and follow-up (FU) angiography. The secondary endpoints were procedure-related complications, rate of re-treatment, and clinical outcome. RESULTS Endovascular treatment was feasible in 36/38 aneurysms (95%). The most frequent strategy was coiling (21/36, 58%), followed by SAC (7/36, 19%), WEB embolization (6/36, 17%) and flow diversion (2/36, 6%). A successful aneurysm occlusion (defined as RROC 1 and 2) on the final angiogram was achieved in 30/36 (83%) aneurysms including all patients presenting with baseline subarachnoid haemorrhage and 25/36 (69%) were occluded completely. Complete occlusion (RROC 1) was more frequently achieved in ruptured BAFAs (15/25, 60% v. 2/11, 18%; p = 0.031). Procedure-related complications occurred in 3/36 (8%) aneurysms. Re-treatment was executed in 12/36 (33%) aneurysms. After a median angiography FU of 38 months, 30/31 (97%) BAFAs were occluded successfully and 25/31 (81%) showed complete occlusion. CONCLUSION Reconstructive endovascular treatment of BAFAs is technically feasible with a good safety profile. Although in some cases re-treatment was necessary, a high rate of final aneurysm occlusion was achieved.
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Affiliation(s)
- Hanna Styczen
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
| | - Sebastian Fischer
- Department of Radiology, Neuroradiology and Nuclear Medicine, Ruhr-University Bochum, Germany
| | - Matthias Gawlitza
- Institute of Neuroradiology, University Hospital Carl Gustav Carus, Germany
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Germany
| | - Lukas Goertz
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Germany
| | - Christoph Maurer
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Germany
| | - Maria Alexandrou
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Bremen-Mitte, Germany
| | - Ali Khanafer
- Neuroradiological Clinic, Klinikum Stuttgart, Germany
| | - Donald Lobsien
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Helios General Hospital Erfurt, Germany
| | - Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
| | - Joachim Klisch
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Helios General Hospital Erfurt, Germany
| | - Christoph Kabbasch
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Germany
| | - Ansgar Berlis
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Germany
| | - Panagiotis Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Bremen-Mitte, Germany.,Department of Radiology, Aretaieion University Hospital, Greece
| | - Hans Henkes
- Neuroradiological Clinic, Klinikum Stuttgart, Germany
| | - Volker Maus
- Department of Radiology, Neuroradiology and Nuclear Medicine, Ruhr-University Bochum, Germany
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Korkmaz M, Çınar C, Nas ÖF, Hakyemez B, Oran İ. Endovascular treatment modalities for basilar artery fenestration aneurysms: experience of two centers and literature review. Turk J Med Sci 2021; 51:1049-1057. [PMID: 33356025 PMCID: PMC8283513 DOI: 10.3906/sag-2006-352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/26/2020] [Indexed: 11/24/2022] Open
Abstract
Background/aim The aim of this study is to present our experience on various endovascular treatment modalities of basilar fenestration aneurysms and reviewing our findings together with literature data. Materials and methods A total of 26 basilar artery fenestration (BAF) aneurysms in 24 patients were endovascularly treated in two different neurointerventional radiology clinics. All patients had been evaluated with computed tomography (CT), CT angiography, and digital subtraction angiography before the procedure. Results Aneurysms of all patients were successfully occluded (technical success rate 100%). Procedure-related complications were seen in two patients. Our comprehensive literature research revealed that studies related with the topic are composed mostly of case reports. In the literature, a total of 113 BAF aneurysms of 101 patients had been treated endovascularly in 46 studies between 1993 and 2019. Success rate of the treatment was reported as 97%, clinical success rate as 91%, and complication rate as 8.8%, while these rates are 100%, 92%, and 7.6% in our study, respectively. Conclusion Although the number of cases is low in our study, to our knowledge, it is the widest series in the literature until today. Our results demonstrate that BAF aneurysms can be treated successfully and safely with different endovascular techniques, with more stent use in recent years.
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Affiliation(s)
- Mehmet Korkmaz
- Department of Radiology, Faculty of Medicine, Kütahya Health Sciences University, Kütahya, Turkey
| | - Celal Çınar
- Department of Radiology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Ömer Fatih Nas
- Department of Radiology, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
| | - Bahattin Hakyemez
- Department of Radiology, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
| | - İsmail Oran
- Department of Radiology, Faculty of Medicine, Ege University, İzmir, Turkey
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Murumkar V, Jabeen S, Peer S, Ramalingaiah AH, Saini J. Ruptured vertebrobasilar junction aneurysm unmasking subclavian steal syndrome. Surg Neurol Int 2020; 11:419. [PMID: 33365182 PMCID: PMC7749953 DOI: 10.25259/sni_561_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/17/2020] [Indexed: 11/04/2022] Open
Abstract
Background Subclavian steal occurs due to stenosis or occlusion of the subclavian artery or innominate artery proximal to the origin of the vertebral artery. Often asymptomatic, the condition may be unmasked due to symptoms of vertebrobasilar insufficiency triggered by strenuous physical exercise involving the affected upper limb. The association of vertebrobasilar junction (VBJ) aneurysms with subclavian steal syndrome has been rarely reported. Hereby, we present a case of VBJ aneurysm associated with subclavian steal treated successfully with endovascular coiling. Case Description A 65-year-old female presented in the emergency department with acute severe headache and vomiting with no focal neurological deficits. Non-contrast computed tomography of the brain showed modified Fischer Grade 3 subarachnoid hemorrhage. Subsequent digital subtraction angiogram (DSA) showed VBJ aneurysm directed inferiorly with the left subclavian artery occlusion. There was retrograde filling of the left vertebral artery on right vertebral injection, confirming the diagnosis of subclavian steal. Balloon assisted coiling of the VBJ aneurysm was performed while gaining access through the stenotic left vertebral artery ostium which provided a more favorable hemodynamic stability to the coil mass. Conclusion Subclavian steal exerting undue hemodynamic stress on vertebrobasilar circulation can be an etiological factor for the development of the flow-related aneurysms. Access to the VBJ aneurysms may be feasible through the stenosed vertebral artery if angioplasty is performed before the coiling of the aneurysm.
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Affiliation(s)
- Vivek Murumkar
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shumyla Jabeen
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sameer Peer
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Ahuja CK, Joshi M, Mohindra S, Khandelwal N. Vertebrobasilar Junction Aneurysm Associated with Subclavian Steal: Yet another Hemodynamic Cause for Aneurysm Development and Associated Challenges. Neurol India 2020; 68:708-709. [PMID: 32643699 DOI: 10.4103/0028-3886.288981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Chirag Kamal Ahuja
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, India
| | - Manisha Joshi
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, India
| | - Sandeep Mohindra
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, India
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Sturiale CL, Stifano V, Della Pepa GM, Albanese A, Fernandez E, Marchese E, Puca A, Sabatino G, Olivi A. Intracranial aneurysms of the posterior circulation associated with a fenestration: a systematic review. J Neurosurg Sci 2019; 63:588-599. [DOI: 10.23736/s0390-5616.18.04225-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Treatment of fenestrated vertebrobasilar junction-related aneurysms with endovascular techniques. J Clin Neurosci 2016; 28:112-6. [PMID: 26778513 DOI: 10.1016/j.jocn.2015.09.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 08/29/2015] [Accepted: 09/19/2015] [Indexed: 11/22/2022]
Abstract
Fenestrated vertebrobasilar junction-related aneurysms (fVBJ-AN) are uncommon and endovascular management strategies have become the first options for the treatment of these lesions. This clinical study aimed to report our experience in the endovascular management of these lesions and to review the literature. We retrospectively reviewed 10 consecutive patients harboring 12 fVBJ-AN between January 2007 and December 2014. The demographic, angiographic and clinical data were reviewed. Additionally, a literature review was performed. Endovascular management strategies were successfully applied in all 10 patients. Post-procedural angiograms indicated total occlusion in eight (66.7%) aneurysms, a residual neck in one (8.3%) aneurysm, and three residual aneurysms (25%). No procedure-related complications were observed. Follow-up angiograms were obtained in eight patients and revealed nine occluded aneurysms and one improved aneurysm; two patients were lost to angiographic follow-up. Clinical follow-ups were obtained in all patients (until July 2015), and the modified Rankin Scale scores at 69.5months (range 17-101months) of follow-up were 0 in eight patients and 1 in two patients. Endovascular management strategies provided a high occlusion rate and an acceptable complication rate and are thus efficacious in the treatment of fVBJ-AN. Further studies are necessary to validate the utility of these treatments due to the low incidence of fVBJ-AN.
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Joshi KC, Thomas A, Jagannatha AT, Garg D. Stent-Assisted Coiling of Aneurysm in a Persistent Primitive Lateral Vertebrobasilar System. World Neurosurg 2015; 86:513.e9-14. [PMID: 26409091 DOI: 10.1016/j.wneu.2015.09.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/02/2015] [Accepted: 09/04/2015] [Indexed: 11/18/2022]
Abstract
Fenestrations of cerebral arteries are relatively common. Knowledge of their structure has recently gained clinical significance with increasing awareness of fenestration aneurysms. Persistent primitive lateral vertebrobasilar (PPLVB) anastomoses are an extreme end of the embryologic mishaps causing these fenestrations, and their occurrence has only been reported twice. We report the first case of an aneurysm within the PPLVB in a patient with unilateral subclavian stenosis. The unique anatomy of these aneurysms and relation with important perforators and brainstem make surgery extremely difficult and require advanced endovascular techniques like balloon remodeling and stent assistance. Three-dimensional rotational angiography can help in providing clarity to the aneurysmal anatomy and planning treatment. The purpose of this case report is to bring to notice the possibility of such aneurysms and use the unique anatomy to understand various tools available in the endovascular surgeon's armamentarium.
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Affiliation(s)
- Krishna Chaitanya Joshi
- Institute of Neurosciences, M S Ramaiah Medical College, MSR Nagar, MSRIT Post, Bangalore, Karnataka, India.
| | | | - Aniruddha T Jagannatha
- Institute of Neurosciences, M S Ramaiah Medical College, MSR Nagar, MSRIT Post, Bangalore, Karnataka, India
| | - Deepali Garg
- Department of Neuroanesthesia, NIMHANS, Bangalore, India
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Graziano F, Ganau M, Iacopino DG, Boccardi E. Vertebro-basilar junction aneurysms: a single centre experience and meta-analysis of endovascular treatments. Neuroradiol J 2014; 27:732-41. [PMID: 25489898 DOI: 10.15274/nrj-2014-10100] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 09/23/2014] [Indexed: 11/12/2022] Open
Abstract
Vascular lesions of the vertebrobasilar junction (VBJ) are challenging in neurosurgical practice, and their gold-standard therapy is still under debate. We describe the operative strategies currently in use for the management of these complex vascular lesions and discuss their rationale in a literature meta-analysis and single centre blinded retrospective study. The single centre study included a review of initial presentation, angiographic features and clinical outcome (with modified Rankin Scale [mRS] scores) over a long-term follow-up. In our series, small aneurysms were effectively treated by endosaccular coil embolization, whereas a strategy including flow-diverter devices combined with endosaccular coil embolization was the option of choice in large and giant aneurysms, leading to satisfactory outcomes in most cases. Our Medline review showed that endovascular treatment was chosen in most VBJ cases, whereas the microsurgical option was assigned to only a few cases. Among the endovascular treatments, the most common techniques used for the treatment of VBJ aneurysms were: coiling, stent-assisted coiling and flow diversion. Our study highlights that aneurysm morphology, location and patient-specific angio-architecture are key factors to be considered in the management of VBJ aneurysms. Most case series, including our own, show that parent artery reconstruction using a flow-diverter device is a feasible and successful technique in some cases of giant and complex aneurysms (especially those involving the lower third of the basilar artery) while a "sit back, wait and see" approach may represent the safest and most reasonable option.
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Affiliation(s)
- Francesca Graziano
- Neurosurgical Clinic, "P. Giaccone" University Hospital, Palermo University Palermo; Palermo, Italy -
| | - Mario Ganau
- Graduate School of Biomedical Engineering, University of Cagliari; Cagliari, Italy
| | | | - Edoardo Boccardi
- Department of Neuroradiology, Niguarda Ca' Grande Institution; Milan, Italy
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