Technical noteT-microstent-assisted coiling in the management of ruptured wide-necked anterior communicating artery aneurysms: Choosing between Y, X and T

- A ruptured wide-necked AcomA aneurysm arose from a dominant unilateral ACA trunk.
- Stent-assisted coiling was performed via 2 simultaneous microsystems.
- 2 nitinol expandable stents were placed as a “T”, preserving AcomA patency.
- The aneurysm was completely occluded without complications.
- The patient had a full neurological recovery.

Anterior communicating artery aneurysms frequently present wide necks and incorporate parent vessels. They are associated with significant variations in vascular anatomy, especially hypoplasia or aplasia of one of the proximal anterior cerebral arteries. Safe and complete endovascular occlusion of these aneurysms usually requires the assistance of complex approaches including dual stenting. We describe a technique for T-configured stent-assisted coiling in the management of ruptured wide-necked AcomA aneurysms by means of two simultaneous microsystems that allowed placement of two nitinol self-expandable Leo+ Baby stents (Balt Therapeutics, Montmorency, France) followed by coiling. Technical details and comparison to other dual stent configurations were presented and briefly discussed.