[A case of a vertebral artery fusiform aneurysm treated with stent assisted coil embolization: technique to prevent...

Placement of a stent over the aneurysm neck and secondary coil embolization prevents coil migration and allows attenuated packing of the coils. However, during the course of the embolization, coils project over and obscure the parent vessel. Here we report a novel technique for endovascular parent vessel reconstruction with aneurysm embolization. A 73-year-old male had an incidental fusiform aneurysm at the V4 segment of the left vertebral artery. The size of the aneurysm increased from 7 mm to 8 mm in diameter. Since the right vertebral artery was hypoplastic, endovascular parent vessel reconstruction with coil embolization was performed. A flexible balloon-expandable coronary stent was navigated to the lesion and deployed successfully followed by coil embolization using a microcatheter through the stent. The balloon was inflated intermittently during coil insertion avoiding coil migration to inside the stent. Furthermore, the angle of the image intensifier was manipulated to visualize the inside of the stent. Postoperative course was uneventful and follow-up MRI three moths later demonstrated obliteration of the aneurysm and patency of the parent artery. This technique provides a practical treatment strategy for the management of a circumferential aneurysm.