X-microstenting and transmesh coiling in the management of wide-necked tent-like anterior communicating artery aneurysms

Anterior communicating artery (AcomA) aneurysms frequently have wide necks and an irregular shape, incorporate parent vessels, and are associated with significant variations in vascular anatomy. Safe and complete endovascular occlusion of these aneurysms usually requires the assistance of combined approaches using balloons and stents in an individually tailored strategy. We describe a technique for X-configured stent-assisted coiling in the management of a small tricuspid tent-like wide-necked AcomA aneurysm by means of two crossed nitinol self-expandable Leo+ Baby stents (Balt Therapeutics, Montmorency, France) followed by “in stent” transmesh coiling. The addition of a low-profile stent into the neurointerventional armamentarium will substantially enhance our capability to treat previously uncoilable tent-like AcomA aneurysms.