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"Cross-over" technique for horizontal stenting of an internal carotid bifurcation aneurysm using a new
Goetz Benndorf1, Richard P Klucznik, Denise Meyer
1Department of Radiology, Baylor College of Medicine, The Methodist Hospital, Houston, Texas 77030, USA. benndorf@.bcm.tmc.edu
Objective And Importance:
To describe the use of a newly available self-expandable stent in a cross-over approach for treatment of a large, wide-necked carotid termination aneurysm.
Clinical Presentation:
A 58-year-old hypertensive woman presenting with mild headaches underwent computed tomography, which showed a nonruptured aneurysm of the left internal carotid artery. She subsequently underwent cerebral angiography, confirming that the aneurysm was located at the left terminal carotid segment with a wide neck.
Intervention:
Using a cross-over approach from the contralateral internal carotid artery, a new self-expandable stent was advanced through the anterior communicating artery and placed horizontally across the aneurysm neck. Aneurysm occlusion was performed by subsequent trans-stent catheterization of the aneurysm and coil packing.
Conclusion:
Successful stent placement allowed subtotal coil occlusion of the aneurysm with a good anatomic and clinical result. No complications were encountered. The new self-expandable stent is a highly flexible, low-profile device that can be safely navigated through tortuous intracranial vessels even in a crossover technique. Its radial force and closed cell design is suitable for stent-assisted coiling and may be superior to stents with an open cell design.
