C38 Successful endovascular management of a ruptured dissecting aneurysm with a loop configuration located in the distal segment of the basilar artery: a case report

<h3>Introduction</h3> Subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysms in the posterior circulation, presents a significant clinical challenge with high morbidity and mortality. Dissecting aneurysms of the basilar artery (BA) are rare and often require complex therapeutic decisions. We report a case of a dissecting basilar artery aneurysm with an unusual loop configuration treated successfully using endovascular techniques. <h3>Case Description</h3> 58-year-old female intubated with crtical neurological status (GCS 7) was admitted to the ED. neCT scan revealed SAH in the basilar cisterns – Fisher grade 4. Angio-CT demonstrated a dissecting aneurysm at the BA bifurcation with a atypical loop configration (Fig.1A-D). Arteriography revealed a ruptured dissecting aneurysm involving the terminal portion of the BA and proximal segments of the PCA’s. Endovascular treatment with a flow diverter stent Pipeline flex 3.25x12 mm, LVIS EVO 3,5x17mm and embolization coils was successfully performed (Fig. 2A-B). The patient‘s postoperative course was satisfactory – regained consciousness with no focal neurological deficits. Follow-up arteriography after 14 days demonstrated minor early recanalisation in the basal part of the aneurysmal loop, prompting a second endovascular procedure during which an additional flow diverter Pipeline Vantage 3,5x12mm was implanted (Fig. 3A-B). The patient was discharged in good neurological condition. <h3>Conclusions</h3> Basilar artery disssecting aneurysms with atypical configuration are associated with a high risk of recanalization and secondary bleeding, thus their treatment require the most effective endovascular techniques and devices. Endovascular embolisation using flow diverter-assisted coiling is a good option for effective treatment unusual loop shape dissecting basilar artery aneurysm to obtain satisfactory clinical results. <h3>Conflict of Interest</h3> No