Anterior Communicating Artery Aneurysm: Incidental Wide-Necked Aneurysm and Stent-Anssisted Coil Occlusion Using a Barrel Stent with Transient In-Stent Stenosis
An 83-year-old woman presented with an ischemic stroke in the supply territory of both anterior cerebral arteries (ACAs). During the diagnostic work-up, a midsized, wide-necked aneurysm of the anterior communicating artery (AcomA) was found. The right A1 segment was missing, and both ACAs were dependent on the left A1 segment. The aneurysm had to be treated while still preserving this solitary left-hand A1 supply channel to both A2 segments. It was decided to treat the patient with stent-assisted coil occlusion. The aneurysm was successfully treated using this method and a Barrel vascular reconstruction device (VRD; AKA “Barrel stent”) (Medtronic). There was a good clinical outcome with no neurological deficits. That the aneurysm had been completely occluded was confirmed by a follow-up DSA after 3 months. This also revealed moderate in-stent stenosis. This stenosis remained asymptomatic and resolved under continued dual platelet function inhibition. Using a Barrel stent as an assist device to treat wide-necked bifurcation aneurysms is the main topic of this chapter.
KeywordsAnterior communicating artery Wide-necked bifurcation aneurysm Barrel VRD 3D coil Emboli from aneurysm
The authors are most grateful to Sabine Wolff (Medtronic), who supported us with knowledge and material.
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