The role of controlled anticoagulation in balloon occluding vertebral arteries to treat giant fusiform aneurysms of the basilar artery

We suggest and discuss the role of controlled anticoagulation therapy after the balloon occlusion of vertebral arteries to treat giant fusiform aneurysms in the basilar trunk. Two cases of giant fusiform aneurysms were treated with balloon occlusion of vertebral arteries. Both of these patients suffered severe brain stem ischaemia. Anticoagulants were used to adjust the PTT to 1.5-2.5 times the normal level to control the formation speed of thrombosis inside the aneurysms. Case 1 was obliged to suspend the anticoagulation therapy one week after occlusion because of digestive tract haemorrhage, and died of severe brain stem ischaemia. On autopsy, the sac of the aneurysm was totally occupied by the thrombus. Two perforating arteries feeding the brain stem arising from the wall of the aneurysm and infarction in the brain stem were found. Case 2 was anticoagulated strictly and progressively improved after three weeks. Anticoagulation was terminated after one month. Follow-up MRI showed the aneurysm had disappeared six months later. Giant fusiform aneurysms in the basilar artery trunk can be treated with the balloon occlusion of vertebral arteries which induces thrombosis in the sac of aneurysm. Controlled anticoagulation should be given to slow down the thrombotic obliteration in the perforators arising from the aneurysm wall to the brain stem and give the brain stem have enough time to establish the sufficient collateral circulation.