An Aneurysm at the Origin of a Duplicated Middle Cerebral Artery Treated by Stent-Assisted Coiling Using the "Wrapped-Candy" Low-Profile Visualized Intraluminal Support (LVIS) Technique: A Technical Case Report and Review of the Literature

World Neurosurg. 2020 Nov:143:353-359. doi: 10.1016/j.wneu.2020.08.046. Epub 2020 Aug 10.

Abstract

Background: Aneurysms at the origin of a duplicated middle cerebral artery (DMCA) are quite rare. Here, we report a patient with such an aneurysm successfully treated endovascularly using our novel "wrapped-candy" low-profile visualized intraluminal support (LVIS) technique.

Case description: A 44-year-old woman underwent endovascular treatment for an unruptured wide-necked aneurysm at the origin of a DMCA that incorporated the origin of the DMCA into its neck. Stent-assisted coiling was performed using our newly developed "wrapped-candy" LVIS technique. To protect the origin of the DMCA and increase the stent metal density at the neck, an LVIS blue 3.5-mm × 22-mm stent was deployed by pushing the delivery wire aggressively to transform the visible wire components of the LVIS into a shape like "wrapped candy," maximizing the strut compaction at the neck of the aneurysm. Subsequently, the aneurysm component was coiled using a jailed microcatheter. The final procedural angiography demonstrated almost complete aneurysm occlusion with DMCA preservation.

Conclusions: Stent-assisted coiling can be a feasible treatment for an unruptured, usually wide-necked, aneurysm at the origin of a DMCA. The wrapped-candy LVIS technique may be useful in more challenging morphologies such as wide-necked aneurysms that incorporate the branch origin into the aneurysm neck.

Keywords: Cerebral aneurysm; Coil embolization; Duplicated middle cerebral artery; LVIS stent; Stent-assisted coiling; Wide-necked aneurysm.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Catheters
  • Cerebral Angiography
  • Endovascular Procedures / methods*
  • Female
  • Humans
  • Intracranial Aneurysm / etiology
  • Intracranial Aneurysm / surgery*
  • Male
  • Middle Aged
  • Middle Cerebral Artery / abnormalities*
  • Middle Cerebral Artery / surgery*
  • Neurosurgical Procedures / methods*
  • Stents*
  • Treatment Outcome
  • Young Adult