Basilar artery aneurysm coiling [Neurosurgery Wiki]

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====== Basilar artery aneurysm coiling ======

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[[Basilar artery aneurysm]] [[coiling]] is a [[minimally invasive]] [[procedure]] that is used for [[basilar artery aneurysm treatment]].

Coiling is a safer and less invasive alternative to open surgery for [[basilar artery aneurysm treatment]]. It has a lower risk of complications and a shorter recovery time. However, not all aneurysms can be treated with coiling.
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Currently, endovascular coiling is a popular treatment for basilar tip aneurysms, which usually involve a wide neck. Serious complications can occur when the [[posterior cerebral artery]] (PCA) originating from a wide neck is not properly preserved. Accordingly, various adjunctive procedures using stents or a balloon have been introduced. 
Kim et al. reported two cases of basilar tip aneurysms in which retrograde horizontal (from one PCA to the other PCA) stent-assisted coiling was successful and provided a summary of the important technical points
((Kim YJ, Sung JH, Hong JT, Lee SW. Horizontal Stent Assisted Coiling of Wide Neck Basilar Tip Aneurysm: Comparison of Two Cases. J Cerebrovasc Endovasc Neurosurg. 2017 Sep;19(3):201-206. doi: 10.7461/jcen.2017.19.3.201. Epub 2017 Sep 30. PMID: 29159154; PMCID: PMC5680084.))
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Wang et al. found that for BA trunk aneurysms, single coiling or conventional low-metal-coverage stent-assisted EVT still had some risks. The risks are mainly from brainstem ischemia. Therefore, the perforators of the BA trunk must be carefully evaluated and prevented from receiving damage from the EVT procedure. This study also shows that 82.1% of patients recovered well. Therefore, EVT can result in an acceptable prognosis
((Wang Y, Xu K, Song J, Yu J. Endovascular Therapy for Basilar Arterial Trunk Aneurysms. Front Neurol. 2021 Feb 15;12:625909. doi: 10.3389/fneur.2021.625909. PMID: 33658978; PMCID: PMC7917204.))
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Coiling of very large and giant basilar tip aneurysms is associated with reasonably low morbidity. Although additional treatment during follow-up is frequently necessary, rebleeding is uncommon
((van Rooij WJ, Sluzewski M. Coiling of very large and giant basilar tip aneurysms: midterm clinical and angiographic results. AJNR Am J Neuroradiol. 2007 Aug;28(7):1405-8. doi: 10.3174/ajnr.A0556. PMID: 17698553; PMCID: PMC7977636.))