Endovascular treatment of a large aneurysm arising from a basilar trunk fenestration using the waffle-cone technique

OBJECTIVE: Endovascular treatment of large intracranial aneurysms arising from a fenestrated parent vessel may prove particularly difficult. We present a case of a large, broad-based aneurysm arising from a proximal basilar artery (BA) fenestration treated with the waffle-cone technique. Technical nuances and indications for this treatment option are reviewed. CLINICAL PRESENTATION: A 38-year-old man presented with headache, blurred vision, and dizziness. Angiography demonstrated an 11 × 14-mm BA aneurysm associated with the proximal portion of a BA fenestration. TECHNIQUE: A 28 × 4.5-mm Enterprise stent was placed from the right vertebral artery directly into the aneurysm. The stent tines were allowed to flare out in the aneurysm neck creating the "waffle cone." The aneurysm was then coiled with a series of Presidio coils. CONCLUSION: Use of the waffle-cone technique for stent placement resulted in nearly complete embolization of the aneurysm, retention of the entire coil mass in the dome, and preservation of flow through both vertebral arteries and both limbs of the fenestration.