The Role of Controlled Anticoagulation in Balloon Occluding Vertebral Arteries to Treat Giant Fusiform Aneurysms of the Basilar Artery

Abstract

We suggest and discuss the role of controlled anticoagulation therapy after the balloon occlusion of vertebral arteries to treat giant fusiform aneurysms in the basilar trunk.

Two cases of giant fusiform aneurysms were treated with balloon occlusion of vertebral arteries. Both of these patients suffered severe brain stem ischaemia. Anticoagulants were used to adjust the PTT to 1.5–2.5 times the normal level to control the formation speed of thrombosis inside the aneurysms.

Case 1 was obliged to suspend the anticoagulation therapy one week after occlusion because of digestive tract haemorrhage, and died of severe brain stem ischaemia. On autopsy, the sac of the aneurysm was totally occupied by the thrombus. Two perforating arteries feeding the brain stem arising from the wall of the aneurysm and infarction in the brain stem were found. Case 2 was anticoagulated strictly and progressively improved after three weeks. Anticoagulation was terminated after one month. Follow-up MRI showed the aneurysm had disappeared six months later.

Giant fusiform aneurysms in the basilar artery trunk can be treated with the balloon occlusion of vertebral arteries which induces thrombosis in the sac of aneurysm. Controlled anticoagulation should be given to slow down the thrombotic obliteration in the perforators arising from the aneurysm wall to the brain stem and give the brain stem have enough time to establish the sufficient collateral circulation.

Keywords

giant fusiform aneurysm basilar artery interventional neuroradiology anticoagulation treatment

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References

Drake

: Giant intracranial aneurysms: Experience with surgical treatment in 176 patients. Clin Neurosurg 26: 12–95, 1979.

McMurtry

III Housepian

: Surgery treatment of basilar artery aneurysms. Elective circulatory arrest with thoracotomy in 12 cases. J Neurosurg 40: 486–494, 1974.

Samii

Turcl

: Possibility of the excision of aneurysms in the vertebrobasilar system followed by end-to-end anastomosis for the maintenance of circulation. Neurol Res 7: 39–45, 1985.

Drake

. Ligation of the vertebral (unilateral or bilateral) or basilar artery in the treatment of large intracranial aneurysms. J Neurosurg 43: 255–274, 1975.

Aymard

Gobin

: Endovascular occlusion of vertebral arteries in the treatment of unclippable vertebrobasilar aneurysms. J Neurosurg 74: 393–398, 1991.

Gobin

Viñuela

: Treatment of large and giant fusiform intracranial aneurysms with Guglielmi detachable coils. J Neurosurg 84: 55–62, 1996.

Steinberg

Drake

Peerless

: Deliberate basilar or vertebral artery occlusion in the treatment of intracranial aneurysms: Immediate results and long-term outcome in 201 patients. J Neurosurg 79: 161–173, 1993.

Fox

Viñuela

: Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms. J Neurosurg 66: 40–46, 1987.

Forsting

Resch

: Balloon occlusion of a giant lower basilar aneurysm: Death due to thrombosis of the aneurysm. Am J Neuroradiol 12: 1063–1066, 1991.