case_images: PMC11789908_01
case_images: Shifting phenomenon of the jailed microcatheter posteriorly after horizontal stenting. (A) Partially deployed coils (arrow) using a jailed microcatheter and a stent-loaded microcatheter in the left P1. (B) Note the proximal stent markers (arrowhead) fanned out in the right P1, the tip of the microcatheter (black arrowhead) after releasing the stent, and shifted jailed microcatheter containing a predeployed coil (arrow) immediately after horizontal stenting. (C) Lateral view showing the microcatheter tip (arrow) shifted towards the rear of the deployed stent and coils packed in the posterior part of the aneurysm. (D) Insufficient coil filling in the anterior part of the aneurysm (arrow). Note: The prior coiled aneurysm at right anterior cerebral artery. (E) Additional coils inserted through the repositioned microcatheter with an anteriorly located tip (arrow). (F) Final angiography showing complete occlusion.
case_images: medi-104-e41451-g001.jpg
case_images: PMC11789908_01_medi-104-e41451-g001.jpg
case_images: F1
case_images: CA) was navigated to the P1 segment of the left posterior cerebellar artery (PCA) to deliver the 3 x 15 mm Neuroform Atlas stent (Fig. 1A). After deploying the horizontal stent from left P1 to right P1, across the aneurysmal neck, the jailed microcatheter was shifted, and a predeployed coil loop was tilted (Fig. 1B). Coiling was then performed through the microcatheter positioned posterior to the deployed stent (Fig. 1C). A lateral view revealed insufficient coil filling in the anterior part of the aneurysm (Fig. 1D). The lateral view demonstrated the buttress of the stent and fully packed coils gripping the stent after coiling (Fig. 1E). The aneurysm was completely occluded (Fig. 1F).
case_images: PMC11789908_02
case_images: Shifting phenomenon of the jailed microcatheter anteriorly after horizontal stenting. (A) Left vertebral angiography after stent deployment showing proximal stent markers (arrow) fanned out near the orifice of the right superior cerebellar artery. (B) Lateral view showing the microcatheter tip (arrow) shifted towards the front of the deployed stent. (C) Insufficient coil filling in the posterior part of the aneurysm. (D) Additional coils inserted through the repositioned microcatheter with a posteriorly located tip (arrow). (E) Final angiography showing complete occlusion. (F) A 4-year follow-up time-of-flight MR angiography showing no recurrence of the treated aneurysm.
case_images: medi-104-e41451-g002.jpg
case_images: PMC11789908_02_medi-104-e41451-g002.jpg
case_images: F2
case_images: DSA after the deployment of the 3 x 15 mm Neuroform Atlas stent (Stryker Neurovascular, Fremont, CA) showed horizontally fanned out stent markers near the orifices of the right PCA and right superior cerebellar artery (Fig. 2A). On the lateral view of DSA, the microcatheter tip within the aneurysm was shifted to the anterior side of the deployed stent (Fig. 2B). Coils were mostly inserted in the anterior part of the aneurysm (Fig. 2C). The microcatheter was then repositioned to the posterior remnant sac, and coiling was successfully completed (Fig. 2D). Final angiography revealed complete occlusion of the aneurysm (Fig. 2E). A follow-up MRI 4 years later showed no recurrence of the treated aneurysm (Fig. 2F).