Endovascular Treatment of Ruptured Large or Wide-Neck Basilar Tip Aneurysms Associated with Moyamoya Disease Using the Stent-Assisted Coil Technique

Abstract

Background: Endovascular coiling is preferred to surgical clipping for the treatment of basilar tip aneurysms (BTAs) associated with moyamoya disease (MMD). However, there are few reports addressing the safety of stent treatment of aneurysms located on unaffected arteries in MMD patients. We report our experiences of stent-assisted coil embolization for ruptured large or wide-neck BTAs associated with MMD.

Methods: A retrospective review was conducted of 5 patients with ruptured BTAs associated with MMD treated by stent-assisted coil from January 2010 to December 2013 in our hospital. All presented with subarachnoid hemorrhage, and the diagnosis was confirmed by digital subtraction angiography. The procedure-related complications, immediate angiographic results, and clinical and angiographic follow-ups were analyzed.

Results: Successful embolization was performed without procedure-related complications in all 5 patients, of whom 3 were treated by single stent-assisted coiling, and the others were treated by Y-configured stent technique. Immediate angiographic results showed complete occlusion in 2 patients, neck residual in 1, and partial occlusion in 2. Postoperative angiographic follow-ups were obtained in all 5 cases at a mean time of 17.6 ± 9.3 months (range, 6-28 months). Follow-up angiographic examinations demonstrated total occlusion without in-stent restenosis in all cases, and all the patients reported good outcomes (modified Rankin Scale score, 0-2).

Conclusions: Endovascular embolization using stent-assisted coiling proved to be a safe and efficient treatment for ruptured large or wide-neck BTAs associated with MMD; however, the long-term safety still remains to be confirmed.

Keywords: Ruptured basilar tip aneurysm; moyamoya disease; stent-assisted coil embolization.