Large, wide-necked basilar apex aneurysms are difficult to treat.
Microsurgical clipping can result in neurologic morbidity and mortality.
Endovascular treatment often leaves remnants that need retreatment and/or stent
placement with dual antiplatelet therapy. The Woven EndoBridge (WEB) is an
intrasaccular flow disruption device that can be used without dual antiplatelet
therapy. However, the WEB cannot typically be used in large or giant aneurysms
>
10 mm because the largest diameter device is the
11 × 9.6 mm single layer sphere (SLS). We present a case in which we use
a PulseRider aneurysm neck reconstruction device in the basilar artery to assist
in WEB deployment within a 22 mm basilar apex aneurysm with 14 mm neck, thereby
permitting aspirin monotherapy postoperatively.