A Case of Repeatedly Recurrent Basilar Trunk Dissecting Aneurysm Successfully Treated by the “Coil Sandwich Technique”

Abstract

Objective: We report a case of dissecting aneurysm of the basilar artery that showed repeated rupture and regrowth but was successfully occluded by "sandwich" placement of a coil between two stents.Case Presentation: The patient was a 41-year-old man. He had subarachnoid hemorrhage (SAH) due to rupture of dissecting aneurysm of the basilar artery 4.5 years before, and a temporary cure was achieved by stent-assisted coil embolization. However, he had SAH again from de novo dissecting aneurysm of the basilar trunk, and, despite repeated treatment by multiple stent-assisted embolization, the aneurysm was recanalized due to coil compaction, and a fourth treatment became necessary. Since it was difficult to insert a microcatheter by the trans-cell approach through three layers of stents, we placed a coil by sandwiching it between two layers of stents in front of the inflow and achieved complete occlusion of the aneurysm. Conclusion:This "coil sandwich technique" is expected to be useful as an option for the treatment of recurrence after stent-assisted coil embolization.Keywords▶ ruptured dissecting aneurysm of the basilar trunk, subarachnoid hemorrhage, stent-assisted coil embolization, coil sandwich technique