Treatment of a middle cerebral artery bifurcation aneurysm using a double neuroform stent "Y" configuration and coil embolization: technical case report.

Objective: Wide-necked cerebral aneurysms have been particularly difficult to treat using coil embolization. The introduction of the first intracranial flexible stent (Neuroform stent; Boston Scientific/Target, Fremont, CA) has provided a great advantage to this dilemma by forming a bridge across the aneurysm neck and allowing the packing of coils. Despite this advancement, some parent vessel bifurcation aneurysms can still remain elusive to single stent and coiling technique.

Methods: A 55-year-old woman presented for a routine follow-up angiogram. Her past history was significant for a subarachnoid hemorrhage and clipping of an anterior communicating aneurysm with full recovery. An incidental new right middle cerebral artery aneurysm was found on the angiogram. We report here a case of an unruptured asymptomatic wide-neck middle cerebral artery bifurcation aneurysm that was treated with a novel endovascular repair. Methods: The aneurysm was successfully treated using a double stent "Y" configuration and coil embolization technique using the Neuroform stent. Technical aspects are discussed. Perioperative management issues and potential pitfalls are also considered.

Conclusions: Double stenting in "Y" configuration and coiling is feasible. This technique should increase the ability to endovascularly treat wide-necked aneurysms.