The "ↃC stenting" for Wide Neck Basilar Apex Aneurysms: A Clinical Case Series and Technical Note

Large, wide-necked basilar artery (BA) apex aneurysms remain challenging to manage despite advances in endovascular techniques, with persistent risks of recurrence and complications, such as parent artery stenosis, perforator occlusion, and in-stent thrombosis. This report introduces a novel endovascular technique, named ''ↃC (double-C) stenting'', for complex BA aneurysms involving the proximal posterior cerebral arteries (PCAs) or superior cerebellar arteries (SCAs). This technique combines bidirectional stenting with coil embolization. From the anterior circulation, a stent or a flow diverter (FD) is deployed from the ipsilateral SCA to the PCA via the posterior communicating artery (PCoA). From the posterior circulation, an additional stent or FD is placed from the contralateral PCA to the BA. Depending on aneurysm morphology and vascular anatomy, either unilateral SCA-P1 stenting combined with contralateral P1-BA stenting or bilateral SCA-P1 stenting is performed. Seven patients with aneurysms ranging from 6.8 to 35 mm, and four aneurysms were partially thrombosed, were treated. Five cases were treated with unilateral SCA-P1 stenting, and two cases were treated with bilateral SCA-P1 stenting. All patients achieved favorable outcomes during the further follow-up period. The ''ↃC stenting" technique requires at least one PCoA but provides a new therapeutic strategy for aneurysms that are difficult to treat using conventional methods.