Balloon occlusion of a giant lower basilar aneurysm: death due to thrombosis of the aneurysm.

Endovascular balloon embolization therapy tor neurovascular lesions was first described by Serbinenko in 197 4 [1). With improved technology, including detachable balloons, minicatheters, permanently solidifying agents, and real-time digital subtraction angiography, it is now possible to treat intracranial arterial aneurysms from an endovascular approach in selected cases [2, 3] . In the case reported here, the patient had a giant aneurysm without a definable neck at the junction of both vertebral arteries; he was treated by bilateral endovascular occlusion of the vertebral arteries distal to the origin of the posterior interior cerebellar arteries. Upon thrombosis of the aneurysm, the patient developed signs of severe brainstem ischemia and ultimately died. At autopsy, occlusion of perforating arteries that arose from the aneurysm sac was found to be the reason tor the fatal outcome of endovascular therapy in this patient.