Complex Stent Reconstruction for the Treatment of Intracranial Aneurysms

The endovascular treatment of intracranial aneurysms has significantly evolved over the past two decades, demonstrating a rapidly improving level of safety and efficacy. In fact, coil embolization with or without device assistance has become the first-line treatment for aneurysms in many centers, especially for aneurysms with a favorable dome-to-neck ratio (>2). However, wide-necked aneurysms are harder to be treated by primary coiling and usually require balloon remodeling or stent reconstructions to adequately cover the aneurysm neck and to avoid coil protrusion and possible compromise of the parent vessel. Stent reconstructions should be individually considered based on cerebral vasculature, aneurysm characteristics, armamentarium available, and neurointerventionalist experience over other technical alternatives. The aim of this chapter is to describe technical nuances and clinical experience with complex stent reconstructions such as Y-stenting, X-stenting, waffle-cone technique, and T-stenting for the treatment of wide-necked aneurysms located at bifurcations. Also, a brief description regarding new technologies for this particular subset of aneurysms is included.