Endovascular Coiling for a Wide-neck Bifurcated Aneurysm with Anterograde Horizontal Stenting via Microcatheter Looping: A Technical Case Report

Abstract

Technical advances with devices such as catheters, balloons, and stents have widened the indications for endovascular coiling for unfavorable aneurysms. The authors report two cases of coil embolization for a wide-neck bifurcated aneurysm with anterograde horizontal stenting via microcatheter looping. Two women, aged 56 and 38 years, respectively, had an undertall- and overwide-neck aneurysm with bifurcated branches at the basilar bifurcation and middle cerebral bifurcation, respectively. The delivery microcatheter was steamed so that it could be looped deliberately to the opposite vessel. The enterprise stent was first anchored to the vessel of the posterior cerebral artery on one side. The remaining portion was spanned into a looped microcatheter to the opposite branch while pushing the stent. The Neuroform Atlas stent was passed directly through the looped segment of the microcatheter at the M2 branch and spanned horizontally by unsheathing. Under horizontal stenting, complete coil embolization was achieved without immediate or delayed complications in both cases. This novel technique presents a viable option for stent-assisted coiling within an optimal anatomy.

Application of the Neuroform Atlas Stent in Intracranial Aneurysms: Current Status

“…In this technique, stenting can be performed via an antegrade approach (48,49). As a low-profile stent, the NAS is appropriate for this technique.…”

“…Then, the curved part of the microcatheter is prepositioned on the opposite side of the efferent vessel by looping. When the NAS is pushed, it can directly pass over the looped segment of the microcatheter, and antegrade NAS deployment is achieved by unsheathing the microcatheter (48). In China, this technique is called the "dragon swaying its tail" technique.…”

“…Antegrade horizontal stenting is not routine and is appropriate only for treating large middle cerebral artery and basilar apex aneurysms with sufficient space to loop the microcatheter. However, microcatheter and NAS delivery can be technically difficult due to the long course that must be navigated, and vessel perforation or dissection may occur during the procedure (48). A shorter NAS can be beneficial for tracking the looping curve.…”

T-Stent or Half T-Stent-Assisted Embolization of Wide-Necked Aneurysms at the Internal Carotid-Posterior Communicating Artery Bifurcation

“…In addition, in deployment of the proximal end of the stent (distal neck of the aneurysm), the stent is deployed distally into the parent artery. Therefore, a technique to deploy the stent by pushing the MC in a looped manner distally into the parent artery (MC looping technique) 14) or to prevent sliding of the stent into the aneurysm, implementation of partial or complete intra-aneurysmal embolization before complete deployment of the stent is necessary. As this technique is applied to wide-necked large aneurysms, there is a risk of recurrence, as in Case 1; therefore, it is necessary to evaluate treatment options in the event of recurrence.…”