Horizontal stenting via retrograde route for recurrent ruptured posterior communicating artery aneurysm after clipping: A case report and literature review

Abstract

Surgical treatment for recurrent aneurysms after clipping is considered cumbersome, especially for reclipping because of existing clips, scar tissue, and severe adhesions. 1,2 Therefore, to avoid additional surgical insult, coil embolization is considered advantageous compared with craniotomy surgery. 3,4 However, endovascular surgery for recurrent aneurysm incorporating a branch vessel arising from the dome is quite difficult. Stent-assisted coiling (SAC) could overcome such difficulties compared with the standard technique. Various stent-assisted techniques have been applied for SAC of bifurcated aneurysms. [5][6][7] Horizontal stenting involves the placement of the stent across the aneurysm neck parallel to the bifurcated branch and axis of the neck, achieving optimal neck formation with only one stent. 8 This procedure reduces the risk of thromboembolic complications and medical costs. 9 In cases of stent deployment for a branch vessel acutely angled from the aneurysm sac, a retrograde approach via the anterior communicating artery (AcomA) allows easier guidance of the microcatheter than the anterograde approach, 9-11 especially for retreatment after clipping. The technical limitations of this approach depend on the AcomA or posterior communicating artery (PcomA) diameter. The NeuroForm Atlas stent (Stryker, Kalamazoo, MI, USA) enables guidance to smaller blood vessels and is easier than guidance via microcatheter since the outer