Combined endovascular stenting and endosaccular coiling for the treatment of a wide-necked intracranial vertebral aneurysm. Technical case report.

SUMMARY: We describe a clinical case of the combined application of endovascular stent placement and GDCoils packing in the management of a ruptured wide necked intracranial aneurysm. A 27-year-old man had a subarachnoid haemorrhage secondary to the rupture of a large wide necked left vertebral aneurysm. This aneurysm was judged to be inoperable. A functional occlusion test failed because of poor collateral flow and combined stenting and coiling was used to occlude the aneurysm with preservation of the parent artery. A femoral approach was used. An 18 mm long ACS((R)) Duet stent was placed across the base of aneurysm and expanded to 4 mm to act as a buttress. A microcatheter was then advanced through the stent mesh and GDC's were deposited for occlusion. This technique provides new possibilities for wide-necked intracranial aneurysms. Further studies are required on the mechanical and thrombogenic properties of stents and on the long-term follow-up, but this technology may play a role in some cases of aneurysm treatment.