Using the snare system to cross the acute-angled vertebrobasilar junction in treating posterior inferior cerebellar artery aneurysm with the stent-assisted method via a retrograde approach. A technical note.

Retrograde stenting via the contralateral vertebral artery (VA) is a safe and effective treatment for posterior inferior cerebellar artery (PICA) aneurysm. Many methods, including tip shaping and the looping technique, have been attempted as ways to cross the vertebrobasilar (VB) junction. Here, we introduce an alternative method using a Snare system to overcome the acute-angled VB junction after repeated failures using other techniques. The Snare system was navigated to the proximal basilar artery via the ipsilateral VA. A guidewire was introduced in the contralateral VA and gently advanced to the basilar artery in order to pass through the loop of the Snare system. Following this, the Snare system caught the guidewire and it was very carefully pulled down to the ipsilateral VA crossing the VB junction. We suggest this technique as a method to cross the acute-angled VB junction after failure of all other attempts to overcome this challenge.