• Jan-Karl Burkhardt, Howard A Riina, Omar Tanweer, Peyman Shirani, Eytan Raz, Maksim Shapiro, and Peter Kim Nelson.
• 1The Irene and Bernard Schwartz Neurointerventional Radiology Center, Departments of Neurosurgery and Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, New York; and.
• J. Neurosurg. 2019 Jun 1; 130 (6): 197819831978-1983.

AbstractThe authors present the unusual case of a complex unruptured basilar artery terminus (BAT) aneurysm in a 42-year-old symptomatic female patient presenting with symptoms of mass effect. Due to the fusiform incorporation of both the BAT and left superior cerebellar artery (SCA) origin, simple surgical or endovascular treatment options were not feasible in this case. A 2-staged (combined deconstructive/reconstructive) procedure was successfully performed: first occluding the left SCA with a Pipeline embolization device (PED) coupled to a microvascular plug (MVP) in the absence of antiplatelet coverage, followed by reconstruction of the BAT by deploying a second PED from the right SCA into the basilar trunk. Six-month follow-up angiography confirmed uneventful aneurysm occlusion. The patient recovered well from her neurological symptoms. This case report illustrates the successful use of a combined staged deconstructive/reconstructive endovascular approach utilizing 2 endoluminal tools, PED and MVP, to reconstruct the BAT and occlude a complex aneurysm.

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