PulseRider “jack-up” technique for wide-necked basilar tip aneurysms that incorporate parent arteries: A technical note

Background: Treatment of intracranial wide-necked bifurcation aneurysms remains challenging. We report a novel PulseRider "jack-up" technique for the treatment of wide-necked basilar tip aneurysms. Case Description: We performed coil embolization in three patients with an unruptured wide-necked basilar tip aneurysm. Aneurysm neck diameters ranged between 7.6 and 11 mm and dome-to-neck ratios ranged from 1.0 to 1.15. All three aneurysms were very shallow with aspect ratios of 0.51-0.69 and incorporated both posterior cerebral arteries into the aneurysm wall. Because each was difficult to embolize using the standard PulseRider procedure, the PulseRider was deployed more proximally than usual and a coil frame constructed above it. Then, the coil was pushed or "jacked up" into the aneurysm with the PulseRider. Adequate embolization was achieved in all three patients. Conclusion: Coil embolization using the PulseRider jack-up technique is effective for treatment of wide-necked basilar tip aneurysms that incorporate parent arteries.