Article Figures & Data
Figures
- Fig 1.
Subtracted PA (A) and lateral (B) pretreatment angiographic projections demonstrate a fusiform aneurysm with incorporation of a 20-mm segment of the midbasilar trunk. The trajectory of the distal basilar artery appears displaced posteriorly and to the right with respect to the trajectory of the proximal basilar trunk. Native PA (C) and lateral (D) projections following treatment demonstrate a 4-PED construct bridging the aneurysmal segment of the basilar trunk. Subtracted PA (E) and slightly oblique (F) projections from 3- (E) and 12-month (F) follow-up angiograms demonstrate an irregularly marginated neck entry remnant along the posterior aspect of the midconstruct, demarcated by dotted circles. Subtracted capillary (G) and late venous (H) phase lateral images from the 12-month follow-up study demonstrate the margins of the residual pocket, demarcated by dotted circles, to be somewhat irregular, with an appearance suggesting gradual penetration into the thrombosed portion of the aneurysm during the later phases of the angiogram. Axial (I) and coronal (J) reformations of source data derived from a cone-beam CTA (DynaCT) following an intra-arterial contrast injection (arrows) demonstrate transit of contrast material through the PED construct with irregular penetration into the intra-aneurysmal thrombus mass. In addition, the overall size of the aneurysm–intra-aneurysmal thrombus mass has not regressed in comparison with original cross-sectional imaging studies obtained before treatment. Subtracted PA (K) and lateral (L) images from an angiogram obtained 10 days after discontinuation of clopidogrel demonstrate complete occlusion of the PED construct. The normal trajectory of the reconstructed basilar artery is demarcated by a dotted line on each image. Subtracted oblique (M) and lateral (N) images demonstrate a large patent right posterior communicating artery providing perfusion of the distal basilar artery and basilar apex. Long TR-weighted axial imagings performed before (O) and 13 months after (P) treatment confirm that the size of the aneurysm-thrombus mass complex had not regressed to any extent after the initial PED reconstruction, suggesting continued viability of the aneurysm despite PED treatment and near-complete thrombosis on angiography during the next 12 months.
- Fig 2.
Subtracted PA (A) and oblique (B) images demonstrate a fusiform aneurysm circumferentially incorporating a 25-mm segment of the basilar artery, extending from just beyond the origin of the AICAs proximally to involve the vertebrobasilar junction. C, Native oblique projection following reconstruction of the vertebrobasilar junction with a PED construct extending from the distal right vertebral artery to the distal basilar artery and coil deconstruction of the distal left vertebral artery. Additional markers within the aneurysm fundus demarcate the ends of 2 Solitaire stents, which had been deployed during a prior (unsuccessful) attempt at treatment. Subtracted angiographic images during the early (D) and mid (E) arterial phases as well as the venous (F) phase from an 11-month follow-up angiogram demonstrate residual filling of the aneurysm via a neck-entry remnant adjacent to the left AICA origin. Later phase imaging demonstrates penetration of contrast material (arrows) deep into the intra-aneurysmal thrombus mass. Subtracted PA image (G) from a 12-month follow-up angiogram demonstrates complete occlusion of the PED construct. H, The normal trajectory of the reconstructed distal right vertebral artery and basilar trunk is demarcated in the adjacent figure by a dotted white line. Subtracted PA angiographic image obtained during the emergent revascularization of the PED construct demonstrates restoration of the patency of the construct with a small amount of residual thrombus material within the basilar apex and proximal posterior cerebral arteries.
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