Massive Dissecting Aneurysm in the Basilar Tip Artery Treated with Intra-aneurysm and Basilar Artery Coiling

INTRODUCTION: Deconstructive versus reconstructive technique remains controversial on the management of acute basilar tip artery dissection. AIM: We introduced a case report of massive dissecting aneurysm in the basilar tip artery treated with intra-aneurysm and basilar artery coiling. RESULTS: A 30-year-old male presented with sudden headache and severe vomiting. Radiographic study showed a large unruptured dissecting aneurysm in the basilar tip artery involving bilateral P1 segment. This aneurysm was treated with intra-aneurysm and basilar artery coiling. Patient was discharge after 7 days without any neurological deficits. Post-operatively, the patient received 75 mg aspirin and 75 mg clopidogrel PO per day for 3 months - then 75 mg aspirin per day for up to 1 year. Angiographic follow-up at 3 months showed a complete occlusion of aneurysmal sac and basilar tip artery without any deficits (mRS 0). Cerebral arteriography at 6 months follow-up confirmed a stable occlusion of aneurysmal sac with a minor recurrence of aneurysm in left P1 segment. CONCLUSION: Intra-aneurysm and basilar artery coiling is valuable alternative technique to treat complex basilar tip dissecting aneurysm in case of infeasible reconstructive technique. Clinical presentation, aneurysm characteristics and collateral circulation have to be investigated on each case to adopt this technique.