Complex basilar artery fenestration aneurysm successfully treated with single flow diverter using novel “crossing flow diverter technique” – A rare case report and review of literature

Abstract

Basilar artery fenestration aneurysms are very rare and endovascular management of large and complex aneurysms is extremely challenging. Most of these type of cases are managed with stent assisted coiling, dual flow diverters (FD) and single FD with additional coiling of aneurysm and occlusion of one of the vertebral artery. Here, we report a case of large complex basilar artery fenestration aneurysm successfully treated with single FD using novel technique called “crossing flow diverter technique” without any additional coiling of aneurysm or occlusion of vertebral artery. Using this technique cost of procedure and procedural complexity inherent with other above mentioned techniques can be significantly reduced.

Reverse Y stenting in the management of vertebrobasilar junction fenestrated aneurysm: A novel technique

“…[ 8 ] Few case reports were available for the treatment of fenestrated aneurysm in basilar artery with FD where kissing FD technique [ 11 ] and crossing FD were used. [ 4 ] Although stent-assisted coiling is less efficacious than FDs and PAO for complete obliteration of these aneurysms, it is effective in reconstructing BA and fenestrated limbs with good aneurysmal occlusion. Furthermore, this technique has a decreased incidence of stroke due to patent perforators and favorable angiographic outcomes, compared with other techniques.…”

“…[ 3 ] Hence, endovascular treatment is the chosen mode of treatment with reasonably good outcomes. [ 4 ] Few conventional methods were published in the literature where these VBJAs were managed with simple coiling, stent-assisted coiling, parent vessel occlusion (PAO), and more recently flow diverter (FD). [ 3 - 6 ] Herein, we report a case of ruptured VBJA, treated by reverse Y stenting with coiling in a middle-aged female.…”