Broad Neck Basilar Tip Aneurysm Treated by Neck Plastic Intra-aneurysmal GDC Embolisation with Protective Balloon.

SUMMARY: A 56-year-old male was found to have a basilar artery aneurysm by magnetic resonance imaging. Angiography demonstrated a broad neck basilar tip aneurysm. He refused surgical clipping but accepted intravascular embolisation. Introducing catheters were inserted into each of the bilateral vertebral arteries. A microcatheter was introduced into the aneurysm through one of the introducing catheters and a double lumen balloon catheter was introduced into the left posterior cerebral artery (PCA) through the other. The balloon was located from the left PCA to the basilar artery across the aneurysmal neck with the aid of a guidewire passed through the inner lumen of the balloon catheter. The balloon was inflated, and a Guglielmi detachable coil (GDC) was inserted until the platinum part was placed inside the aneurysm. The balloon was deflated to confirm the stability of the GDC, and then the GDC was electrically detached. This procedure was repeated until nine GDCs were successfully inserted. The aneurysm was tightly embolised despite its broad neck. Angiography comfirmed complete neck closure and stable preservation of the basilar artery and bilateral PCAs immediately, 1 week, 3 months, 6 months, and 12 months after embolisation without evidence of thrombo-embolic complications. Neck plastic intra-aneurysmal GDC embolisation using a protective balloon can be used to treat broad-neck aneurysms.