[Intentional neck-plastic incomplete clipping followed by coil embolization for broad-necked distal BA aneurysms]

We report three patients with broad-necked distal basilar artery (BA) aneurysms treated with intentional incomplete clipping followed by endovascular occlusion using Guglielmi detachable coils.

The location of the aneurysms was BA bifurcation in one patient and BA-superior cerebellar artery (SCA) in two. One patient presented with acute subarachnoid hemorrhage and two patients had incidental aneurysms. In two patients, endovascular treatment was thought to be difficult considering the morphology of the aneurysms and surgical treatment was performed as the first choice of treatment. One patient with a BA-SCA aneurysm underwent endovascular treatment using a remodelling technique first. However, it was impossible to place the coil preserving SCA, so surgical treatment was performed. In all patients, the attempt to pursue complete clipping was considered to be accompanied with high risks of morbidity, so neck-plastic incomplete clipping was performed intentionally. One to six days after the surgery, coil embolization was performed.

In all patients, complete occlusion of the aneurysms was achieved and all patients had excellent clinical outcomes.

Intentional neck-plastic incomplete clipping followed by endovascular coiling may be a useful treatment option for patients with broad-necked distal BA aneurysms.