Usage of Stent-Assisted Coiling Technique with Atlas Stent for Middle Cerebral Artery Aneurysm with Branch Originating from Aneurysm Sac

Treatment of bifurcation intracranial aneurysms is technically challenging. Sometimes it is necessary to pass a microcatheter through the aneurysm sac to navigate the microcatheter to a branch originating from the aneurysm sac. A 56-year-old male patient was treated for an incidental middle cerebral artery aneurysm. One branch originated from the medial part of the aneurysm sac, therefore stent-assisted coiling technique with an Atlas stent was used for endovascular treatment. After placement of the stent into the M2 branch, the loop of the microcatheter located in the aneurysm sac was pulled back and the microcatheter was straightened and finally the stent was deployed carefully from the M2 segment across the aneurysm sac into the M1 segment of the left middle cerebral artery. Immediately after placement of the stent the microcatheter was positioned easily through the implanted stent by crossing technique and coiling of the intracranial aneurysm was performed in the same session. No reperfusion was found on the 12-month follow-up magnetic resonance angiogram, and no clinical problem occurred during this period.