Article Figures & Data
Figures
- Fig 1.
Algorithm for positioning of the stent in coil embolization of PcomA aneurysms, adjusting for PcomA integration into the aneurysm neck, PcomA type, and angle of PcomA origin.
- Fig 2.
A, If the aneurysm neck mostly incorporates the distal ICA or the coil protrudes into the distal ICA, stent positioning from the distal ICA to the terminal ICA preserves ICA patency. B, If the aneurysm neck mostly incorporates the PcomA or the coil protrudes into the PcomA, stent positioning from the distal ICA to the PcomA preserves PcomA patency. C, If the PcomA warrants protection and originates from the ICA or the aneurysm neck at an acute angle, stent positioning is through the PcomA only, aligning the proximal portion of the stent with the aneurysm neck. D, If the aneurysm neck broadly incorporates both the ICA and the PcomA and the ipsilateral P1 is of sufficient caliber to pass a 0.021 microcatheter for stent delivery, stent positioning is retrograde from the PcomA to the terminal ICA.
- Fig 3.
A, Conventional angiography of the recanalized PcomA aneurysm, mostly incorporating the distal ICA. B, Coil embolization under stent protection (stent placement through the ICA). C, Completion angiography shows satisfactory occlusion of aneurysm. Arrows indicate both ends of the stent.
- Fig 4.
A, Conventional angiography of a wide-neck PcomA aneurysm, incorporating the orifice of the PcomA (fetal type). B, An Enterprise stent (4.5 × 22 mm) is deployed (distal ICA to the PcomA), and a coil is inserted under stent protection. C, Completion angiography shows occlusion of the aneurysm with a residual neck. Arrows indicate both ends of the stent.
- Fig 5.
A, 3D image of a wide-neck PcomA aneurysm, mostly incorporating the orifice of the PcomA (PcomA origin at the ICA forms an acute angle). B, Microcatheter for stent delivery is introduced into the PcomA, while a second microcatheter for coil delivery is advanced into the sac of the aneurysm. C, An Enterprise stent (4.5 × 22 mm) is deployed via the PcomA (aligning the proximal portion of the stent with the neck of the aneurysm) and a coil is inserted successfully under stent protection. D, Conventional angiography 12 months later shows an occluded aneurysm and distal stent migration. Arrows indicate both ends of the stent.
- Fig 6.
A, 3D image of a wide-neck aneurysm at the PcomA orifice, evenly incorporating the ICA and the orifice of the PcomA (PcomA origin at the neck of the aneurysm forms an acute angle). B, Microcatheter for stent delivery is introduced through the ipsilateral P1 and is navigated retrograde into the left distal ICA via the PcomA; then, the Enterprise stent (4.5 × 22 mm) is deployed (PcomA to terminal ICA). C, Completion angiography shows occlusion of the aneurysm with a residual neck after coil insertion under stent protection. Arrows indicate both ends of the stent.
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