Flow Diversion with Low-Profile Braided Stents for the Treatment of Very Small or Uncoilable Intracranial Aneurysms at or Distal to the Circle of Willis

Preprocedural CT and procedural and follow-up angiograms of a 39-year-old female patient with a distal PICA aneurysm. A, CT angiography reconstructed on a sagittal projection shows a saccular aneurysm in the PICA. B, A preprocedural DSA image depicts a 7-mm saccular aneurysm located in the tonsillomedullary segment of the left PICA. C, A roadmap DSA image obtained during the procedure shows the catheterization of the distal PICA for stent placement. This image also demonstrates that the aneurysm has a very complex morphology without a definable neck. D, A nonsubtracted angiography image shows the deployment of the stent into the PICA. Please note the compaction and expansion of the stent across the orifice of the aneurysm. E, A 12-month follow-up DSA image reveals the reconstruction of the parent artery and no aneurysm filling. F, The 24-month follow-up DSA image confirms the stable occlusion of the aneurysm.

Procedural and follow-up DSA images of a 62-year-old female patient with a small posterior cerebral artery aneurysm. A, A preprocedural DSA image obtained in the left anterior oblique projection reveals a 2.5-mm saccular aneurysm (arrow) located in the left posterior cerebral artery. B, The venous phase of the DSA image obtained immediately after stent deployment shows the stagnation of injected contrast medium in the aneurysm sac (black arrow) and the deployed stent (white arrows) in the left posterior cerebral artery. C, The 7-month follow-up DSA image demonstrates total occlusion of the aneurysm (OKM grade D) and a mild degree of in-stent stenosis.