• Stanimir Stefanov Sirakov, Adriana P Panayotova, Alexander S Sirakov, Hristo Hristov, Krasimir Minkin, and Radoslav Raychev.
• Department of Radiology, UH St. Ivan Rilski, Sofia, Bulgaria. Electronic address: ssirakov@bsunivers.com.
• World Neurosurg. 2018 Nov 1; 119: 306-310.

BackgroundFenestration of the basilar artery is a segmental duplication of the vessel due to nonfusion of the embryonal arteries and is the second most common vascular disjunction. Here, we present a single case example demonstrating the utility of the temporary bridging device Comaneci as a new option in the endovascular treatment of ruptured basilar artery aneurysms associated with fenestrations.Case DescriptionA 57-year-old female patient presented to our hospital with a 3-month history of frequent multiple sentinel severe headaches. At the time of hospitalization, the patient was neurologically intact with a Glasgow Coma Scale score of 15. There was no evidence of focal neurologic deficits or cranial nerve lesions, but there was discrete neck stiffness and a diagnosed saccular aneurysm associated with a fenestration of the basilar artery. After multidisciplinary discussion involving neurosurgeons and interventional neuroradiologists and taking into consideration the patient's clinical presentation and previous history of subarachnoid hemorrhage, as well as the morphology of the posterior circulation aneurysm, endovascular treatment of the basilar fenestration aneurysm was deemed appropriate or simply use was chosen.ConclusionsOur case results are similar to previously published good results of endovascular coiling and add information regarding the relatively new Comaneci device, which helped to achieve considerable packing density of the aneurysmal sac. Using this device lowers the risk of peri- and postoperative complications. We believe that this technique is safer and better than the balloon-assisted and stent-assisted coiling in ruptured case scenarios of wide-neck aneurysms in the posterior circulation.Copyright © 2018 Elsevier Inc. All rights reserved.

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