CT Angiography for assessment of intracranial basilar apex aneurysm neck diameter reduction poststenting for treatment planning

Background and Purpose: Once a contraindication for a neuro-interventional therapeutic approach, some wide-necked aneurysms can now be treated with stent assistance. Radiologically assessing the impact of a stent on the neck of a wide-neck bifurcation, aneurysm remains a challenge however. Methods: A 76-year-old female with a large irregular basilar apex aneurysm was referred for endovascular treatment. Angiographic imaging revealed a basilar apex aneurysm with a 6-mm neck and a 14-mm dome. The decision was made to perform staged stent-assisted coiling of the aneurysm. In the interim time, although the stent was allowed to heal in place, a CTA was done to assess the positioning of the stent and the degree of neck narrowing. Results: The CTA showed that the neck had been narrowed from 6 to 2 mm hence making endovascular coiling feasible. Conclusion: Our case illustrates the use of CTA poststent deployment to visualize the change in aneurysm neck caliber precoil embolization.