Endovascular electrothrombosis: A promising alternative for basilar artery perforator aneurysm treatment

Hongyu Ma, Rui Zhao, Yibin Fang, Qiang Li, Pengfei Yang, Qinghai Huang, Yi Xu, Bo Hong, Jian-Min Liu, Hongyu Ma, Rui Zhao, Yibin Fang, Qiang Li, Pengfei Yang, Qinghai Huang, Yi Xu, Bo Hong, Jian-Min Liu

Abstract

Background: Basilar artery perforator aneurysms (BAPAs) are rare. Traditional surgical clipping and endovascular coiling have proven to be challenging. We present three patients treated with endovascular electrothrombosis and describe the characteristics of this new approach.

Methods: Three patients presented with subarachnoid hemorrhages (SAHs). Cerebral angiography identified BAPAs. Endovascular electrothrombosis was performed after obtaining informed consent. We placed the microwire into the sac of the aneurysms through the microcatheter and connected its proximal tip to the Solitaire stent detachment system. Electrothrombosis was conducted using 1.0 mA current.

Results: Two aneurysms were successfully occluded without treatment-related complication. The third one failed and converted to endovascular coiling using a 1.3-F microcatheter. The patient suffered brainstem infarction and finally died of severe SAH. At follow-up, the two patients were neurologically intact and angiography showed total occlusion of both aneurysms.

Conclusion: Endovascular electrothrombosis might be a potential alternative to traditional treatment for BAPAs. Close follow-up with caution should be mandatory. More research is needed to confirm its safety and efficacy.

Keywords: Basilar artery; endovascular procedures; microaneurysm; subarachnoid hemorrhage.

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Patient 1. A 48-year-old man presented with acute SAH (a). Preoperative angiography revealing a BAPA (

Figure 2.

Patient 2. A 65-year-old man…

Figure 2.

Patient 2. A 65-year-old man with brain CT scan revealing diffuse SAH (a).…

Figure 2.
Patient 2. A 65-year-old man with brain CT scan revealing diffuse SAH (a). Cerebral DSA revealing a BAPA at the middle 1/3 of the basilar artery (b). After electrothrombosis for three times, there remained persistent contrast filling of the aneurysm (c). Catheterization was retried and a Target NANO 1/2 coil was successfully inserted into the aneurysm (d and e). Post-operational CT revealed a lacunar infarction of the right brainstem (f).

Figure 3.

Patient 3. A 52-year-old man…

Figure 3.

Patient 3. A 52-year-old man presented with sudden headache. Cranial CT revealing diffuse…

Figure 3.
Patient 3. A 52-year-old man presented with sudden headache. Cranial CT revealing diffuse SAH (a). Cerebral angiography and three-dimensional representation revealing a perforator aneurysm (1.3 mm) near the fenestration of basilar artery (b and c). The electrothrombosis was performed for 1.5 min (d) and the aneurysm disappeared (e). At six-month follow-up, DSA showed no signs of aneurysm recurrence (f).
Figure 2.
Figure 2.
Patient 2. A 65-year-old man with brain CT scan revealing diffuse SAH (a). Cerebral DSA revealing a BAPA at the middle 1/3 of the basilar artery (b). After electrothrombosis for three times, there remained persistent contrast filling of the aneurysm (c). Catheterization was retried and a Target NANO 1/2 coil was successfully inserted into the aneurysm (d and e). Post-operational CT revealed a lacunar infarction of the right brainstem (f).
Figure 3.
Figure 3.
Patient 3. A 52-year-old man presented with sudden headache. Cranial CT revealing diffuse SAH (a). Cerebral angiography and three-dimensional representation revealing a perforator aneurysm (1.3 mm) near the fenestration of basilar artery (b and c). The electrothrombosis was performed for 1.5 min (d) and the aneurysm disappeared (e). At six-month follow-up, DSA showed no signs of aneurysm recurrence (f).

References

    1. Ghogawala Z, Shumacher JM, Ogilvy CS. Distal basilar perforator artery aneurysm: case report. Neurosurgery 1996; 39: 393–396.
    1. Bhogal P, AlMatter M, Hellstern V, et al.. Basilar artery perforator aneurysms: report of 9 cases and review of the literature. J Clin Neurosci 2019; 63: 122–129.
    1. Jiang Y, Luo J, Zheng J, et al.. Endovascular pure electrocoagulation of intracranial perforator blister-like aneurysm not accessible to microcatheter – new approach to treat small vessel hemorrhage disease. Int J Stroke 2016; 11: NP60–1.
    1. Chalouhi N, Jabbour P, Starke RM, et al.. Treatment of a basilar trunk perforator aneurysm with the pipeline embolization device: case report. Neurosurgery 2014; 74: E697–701.
    1. Marinković SV, Gibo H. The surgical anatomy of the perforating branches of the basilar artery. Neurosurgery 1993; 33: 80–87.
    1. Forbrig R, Eckert B, Ertl L, et al.. Ruptured basilar artery perforator aneurysms–treatment regimen and long-term follow-up in eight cases. Neuroradiology 2016; 58: 285–291.
    1. Finitsis S, Derelle AL, Tonnelet R, et al.. Basilar perforator aneurysms: presentation of 4 cases and review of the literature. World Neurosurg 2017; 97: 366–373.
    1. Sanchez-Mejia RO, Lawton MT. Distal aneurysms of basilar perforating and circumferential arteries. Report of three cases. J Neurosurg 2007; 107: 654–659.
    1. Gross BA, Puri AS, Du R. Basilar trunk perforator artery aneurysms. Case report and literature review. Neurosurg Rev 2013; 36: 163–168.
    1. Buell TJ, Ding D, Raper D, et al.. Posterior circulation perforator aneurysms: a proposed management algorithm. J Neurointerv Surg 2018; 10: 55–59.
    1. Chau Y, Sachet M, Sédat J. Super-selective coil embolization of a basilar perforator artery aneurysm previously treated by the stent-in-stent technique, using an extremely soft bare coil delivered through a one-marker microcatheter. Interv Neuroradiol 2017; 23: 492–496.
    1. Peschillo S, Caporlingua A, Cannizzaro D, et al.. Flow diverter stent treatment for ruptured basilar trunk perforator aneurysms. J Neurointerv Surg 2016; 8: 190–196.
    1. Sawyer PN, Pate JW. Bio-electric phenomena as an etio-logic factor in intravascular thrombosis. Am J Physiol 1953; 175: 103–107.
    1. Mullan S, Raimondi AJ, Dobben G, et al.. Electrically induced thrombosis in intracranial aneurysms. J Neurosurg 1965; 22: 539–547.
    1. Jiang Y, Li Y. Treatment of tiny intracranial aneurysms with guidewire manipulation. Chin Neurosurg J 2017; 3: 39.

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