Stent-Assisted Coil Embolization of a Wide-Neck Aneurysm at the Vertebral Artery Terminus Using a Contralateral Approach: A Technical Report

Background—Aneurysms of the vertebrobasilar junction (VBJ) are especially uncommon but carry a significant risk of hemorrhage and historically have been difficult to treat. In recent years, however, advancements in stent-assisted embolization have allowed better access and stabilization of complicated posterior circulation aneurysms. Methods—We describe a novel approach in the treatment of a wide-neck aneurysm at the terminus of the left vertebral artery by a contralateral approach in a patient with ipsilateral subclavian artery occlusion. Results—A complex, wide-neck aneurysm at the verterbrobasilar junction hindered by ipsilateral subclavian occlusion can successfully be treated with stent-assisted coil embolization using a contralateral approach. Conclusion—Contralateral U-shaped stenting offers a viable endovascular option for patients with complex aneurysms of the vertebral basilar junction but should be reserved for appropriate cases with favorable anatomy when the ipsilateral approach from the subclavian artery is unobtainable.