Combination of Multicatheter Plus Stent or Balloon for Treatment of Complex Aneurysms

A 59-year-old woman presenting with an unruptured right ophthalmic artery aneurysm. A, The 3D reconstruction shows a wide-neck and shallow aneurysm with incorporation of the ophthalmic artery. Arrows indicate the ophthalmic artery. Unsubtracted angiogram (B) and flat panel CT (C) after Neuroform stent placement show 2 microcatheter tips in the aneurysm sac, one of which faces the ophthalmic artery origin. Black arrows indicate the struts of the Neuroform stent, and white arrows indicate the ophthalmic artery. Note that the 1 catheter tip (white arrowhead) faces the ophthalmic artery origin and the other catheter tip (black arrowhead) faces the aneurysm dome. D, While a helical 1.5 mm × 2 cm coil (arrowheads) occupies the region (arrow) where the ophthalmic artery branches off and the stent protects the aneurysm neck, an initial coil basket is successfully formed by using the other catheter. E, After retrieval of the protection coil, the initial coil basket is stable and the region from which the ophthalmic artery branches off is well-preserved. F, Completion angiogram indicates that the aneurysm was nearly completely embolized with intentional preservation of the region from which the ophthalmic artery (arrows) branches off. G, The 6-month follow-up MR angiogram source image shows no recurrence. The arrow indicates the ophthalmic artery origin, and arrowheads indicate the coiled aneurysm.