Balloon-Assisted Coiling Followed by Half-T or T Stenting of Unruptured Superior Cerebellar Artery Aneurysms

Superior cerebellar artery (SUCA) aneurysms are rare and anatomically challenging lesions. Surgical and endovascular approaches are complicated by the vessel's small diameter and proximity to eloquent structures. We describe a technique combining balloon-assisted coiling followed by half-T or complete T stent placement using a braided stent, aiming to achieve high occlusion rates with low complication risk.

This retrospective, single-center study included patients with unruptured aneurysms at the origin of the SUCA treated between May 2012 and December 2023. All patients underwent balloon-assisted coiling followed by stent placement in either a half-T or complete T configuration through the remodeling balloon. Clinical and angiographic outcomes, peri- and postprocedural complications, and 12-month follow-up DSA were assessed.

A total of 55 patients were treated. All achieved immediate postprocedural complete occlusion (Raymond-Roy Class I). The overall periprocedural complication rate was 5.5% (n=3), including 2 minor ischemic events and 1 limited arterial dissection without ischemic consequence; none resulted in clinical deterioration or worsening of the mRS score at discharge. No hemorrhagic events were observed. At the 12-month follow-up, 94% of patients maintained Class I occlusion. Favorable clinical outcomes (mRS 0-1) were observed in 92% of patients, of whom 98% demonstrated no change in mRS compared with their preprocedural baseline. Subgroup analysis of patients treated with a complete T configuration showed comparable safety and efficacy outcomes.

Balloon-assisted coiling followed by half-T or complete T stent placement appears to be a safe and effective method for treating unruptured SUCA aneurysms, achieving high and durable occlusion rates. Limitations include retrospective design, a lack of control group, and self-adjudicated results. Further multicenter and core lab validated studies are warranted.