Temporary stent scaffolding during aneurysm coiling.

Area of Science:

• Interventional Neuroradiology
• Neuroendovascular Surgery
• Cerebrovascular Disease

Background:

• Wide-neck aneurysms pose challenges for endovascular embolization, with risks of coil migration and herniation.
• Traditional stent-assisted coiling requires dual antiplatelet therapy, increasing bleeding risks.
• Balloon remodeling can be technically demanding in tortuous anatomy and may cause parent artery occlusion.

Observation:

• A novel technique using a temporary, fully retrievable Solitaire FR stent for scaffolding during coil embolization of an anterior communicating artery aneurysm is presented.
• The stent was recaptured before the final coil detachment, avoiding prolonged antiplatelet use.
• This approach allowed for coil repositioning if needed and offered a fallback option for stent redeployment.

Findings:

• Temporary stent scaffolding facilitated embolization of a large-neck aneurysm, effectively preventing coil herniation.
• The technique avoided the need for prolonged antiplatelet coverage, unlike conventional stent-assisted coiling.
• Compared to balloon remodeling, this method provided easier distal access in challenging anatomy and prevented temporary vessel occlusion.

Implications:

• Temporary stent scaffolding with retrievable devices offers a valuable bailout strategy for specific wide-neck aneurysms, particularly distally located ones.
• This technique expands neuroendovascular treatment options, potentially improving safety and efficacy in complex cerebrovascular cases.
• Further research may validate this approach for a broader range of challenging aneurysm morphologies.