Staged stent-assisted, transcirculatory coiling of partially-thrombosed, mixed saccular and fusiform SCA aneurysm

SCA aneurysms are rare, making data on their management sparse compared to other posterior circulation aneurysms. While saccular aneurysms at the SCA origin can be treated with primary coiling or surgical clipping, fusiform and distal SCA aneurysms often require endovascular techniques such as stent-assisted coil embolization or parent vessel occlusion. We present a case of a mixed saccular/fusiform SCA aneurysm that underwent staged stent-assisted coil embolization. A right SCA stent was placed in the first stage. Given the acute angle between the BA and the SCA, microcatheter access and stent placement proved challenging. The decision was made to allow the stent to endothelialize and return in a staged fashion to perform a trans-radial, transcirculatory (trans-left PCoA, trans-left PCA) coil embolization. This provided a straight course between the left P1 segment and the right SCA origin, allowing easy microcatheter navigation through the stent and into the aneurysm for coil embolization.