Stent reconstruction of wide-necked aneurysms across the circle of Willis.
OBJECTIVE
To describe a novel technique for single stent reconstruction of wide-necked aneurysms arising from the circle of Willis.


METHODS
Neuroform stents (Boston Scientific/Target, Fremont, CA) were placed across the basilar apex (right P1 to left P1) via the posterior communicating artery in two patients, across the left carotid terminus (left A1 to left M1) via the anterior communicating artery in two patients, and across the anterior communicating artery (left A1 to right A1) in one patient for stent-supported coil embolization.


RESULTS
Five women underwent successful deployment of the Neuroform stent across the circle of Willis to support subsequent coil embolization of a wide-necked cerebral aneurysm. In two patients with subarachnoid hemorrhage, initial dome coiling was performed for short-term protection, and stents were applied across the circle of Willis to support completion of coil embolization during a second session. None of the patients experienced any periprocedural or delayed neurological complications.


CONCLUSIONS
Stenting across the circle of Willis represents a novel adjuvant technique to support the coiling of selected wide-necked intracranial aneurysms. This technique is particularly useful for wide-necked terminal aneurysms that incorporate both branches of a bifurcation in a configuration unfavorable for Y-stent reconstruction.
Kelly
Michael E
ME
Division of Cerebrovascular and Endovascular Neurosurgery, Department of Neurosurgery, The Cleveland Clinic, Cleveland, Ohio 44195, USA.
Turner
Raymond
R
Gonugunta
Vivek
V
Woo
Henry H
HH
Rasmussen
Peter A
PA
Masaryk
Thomas J
TJ
Fiorella
David
D
D000328:Adult; D000368:Aged; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002533:Cerebral Angiography / Q000379:methods; D002941:Circle of Willis / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D020769:Posterior Cerebral Artery / Q000473:pathology / Q000601:surgery; D015607:Stents