Coil embolization of wide neck bifurcation aneurysms via 'shouldering' and 'framing': a safe alternative to conventional techniques.

INTRODUCTION: Double stent-assisted coiling of wide-neck bifurcation aneurysms (WNBA) can be technically challenging with high thromboembolic rates. Single stent-assisted coiling (SSAC) decreases procedural complexity and thromboembolic risk but increases risk of coil prolapse and recanalization. In this study, we present our institution's experience with SSAC of WNBA performed via a 'shouldering' and 'framing' with a single Atlas stent and spherical 3D Stryker coil. METHODS: A retrospective review of 35 patients with WNBA who underwent SSAC of WNBA performed via a 'shouldering' and 'framing' with a single Atlas stent and spherical 3D Stryker coil from 2018 to 2019. Data collection was performed on baseline demographics, clinical presentation, aneurysm characteristics, angiographic and functional outcomes, and perioperative and postoperative complications. RESULTS: Of 35 patients, the mean age was 59.9+/-11.6 and 25/35 (71.4%) were female. The mean aneurysm diameter was 6.3mm+/-3.4, the mean neck size was 3.9mm+/-1.3, and the mean dome-to-neck ratio was 1.5+/-0.6. Initial complete/near-complete occlusion was demonstrated in 30/35 (85.7%) patients. On angiographic follow-up at a mean of 6 months, 9/24 (37.5%) patients showed progressive thrombosis, 13/24 (54.2%) showed stable occlusion, and 2/24 (8.5) showed recanalization. Thromboembolic events occurred in 2/35 (5.7%) patients, intraoperative technical complications occurred in 2/35 (5.7%) patients, and access-site complications occurred in 2/35 (5.7%) patients. The were no cases of retreatment, rehemorrhage, or procedural-related permanent morbidity or mortality. CONCLUSION: Coil embolization performed via 'shouldering' with a single Atlas stent and 'framing' with a spherical 3D Stryker coil is a feasible, safe, and effective neuroendovascular treatment for WNBAs.