Endovascular aneurysm treatment has significantly improved over the last three decades. This can be attributed to both advances in experience and technology including catheters, coils, intracranial balloons, and stents. Remodeling of wide-neck aneurysms using intracranial balloons and stents in difficult

over the last three decades. This can be attributed to both advances in experience and technology including catheters, coils, intracranial balloons, and stents. Remodeling of wide-neck aneurysms using intracranial balloons and stents in difficult locations is now possible with a favorable risk profile. In many institutions, stent-assisted coiling is performed in cases where balloon-remodeling is judged to be difficult. There have been many reports in the literature citing novel methods for stent deployment: “Y-stenting”, “Horizontal-stent”, “X-shape stents” ABSTRACT: Introduction: Endovascular coiling of aneurysms crossing the Circle of Willis has been described in small case series. The technical challenges in manipulating a stent across the Circle of Willis lie in negotiating difficult angles and small arteries. We present our experience with treating aneurysms by stent assistance in which the Circle of Willis was crossed to facilitate optimal stent deployment. Materials and methods: We retrospectively reviewed the cases in our institution from January 2009 to June 2012 in which the Circle of Willis was traversed to facilitate optimal stent deployment. We measured the diameter of the communicating arteries traversed, caliber of the target arteries in which the stent was deployed and the most acute angle negotiated (“critical angle”). We compare our results with other published series in the literature. Results: Eight patients fulfilled the criteria: 5 males (45-66 years). There were three anterior and five posterior circulation aneurysms. Four of the aneurysms were ruptured. The PCOM was traversed in five cases, the ACOM in three cases. The mean diameter of the communicating artery was 1.17mm. The mean diameter of target arteries was 1.27mm. The “critical angle” was 72-147 degrees. In all patients, there was satisfactory obliteration of the aneurysm. There were two cases of minor SAH post procedure. Conclusion: Utilizing the Circle of Willis for optimal stent placement in aneurysm remodeling is technically feasible but challenging. This technique can be performed successfully in patients with acute SAH. The procedural risk must be balanced against potential complications such as SAH.