Stent-Assisted Coiling Of A Sidewall Aneurysm Of The Distal Middle Cerebral Artery: 2-Dimensional Operative Video

Sidewall aneurysm treatment often requires complex management strategies. These can include advanced clipping techniques or stent-assisted coiling techniques. Endovascular coiling alone has been associated with high recurrence rates and is often not feasible.(1-4) Flow-diversion embolization has recently become a standard of care for many aneurysms, demonstrating high occlusion rates.(4,5) However, the third generation of coil-assist stents can be delivered with 0.0165 '' microcatheters, being an ideal adjunct to manage this group of aneurysms in more distal locations.In this video, a 16-yr-old teenager with Parry-Romberg syndrome and congenital adrenal hyperplasia had an incidental finding of a 6.5-mm sidewall aneurysm arising off the angular branch of the left middle cerebral artery, found during the work-up of complex partial seizures. The patient consented to the procedure. Due to his young age and aneurysm size, a decision was made to treat the aneurysm through an endovascular approach. Under general anesthesia, a transfemoral approach was carried out using a 6-French short sheath. A 6-French guiding catheter was left in the distal cervical left internal carotid artery; a 0.0165 '' microcatheter was used to first deploy a 3.0 x 15 mm Neuroform Atlas stent, completely covering the length of the aneurysm. Then, the stent was traversed with the microcatheter to coil the aneurysm. Follow-up cerebral angiogram confirmed complete occlusion of the aneurysm.