Low-profile visualized intraluminal support junior-within-enterprise 2 stent technique for a distal middle cerebral artery fusiform aneurysm: A case report

Background: Aneurysms distal to the M2 segment account for 2–7% of middle cerebral artery (MCA) aneurysms. These aneurysms, which are often small and fusiform, have thin walls and are prone to bleeding. Therefore, neck clipping and aneurysmal coil embolization are difficult to perform. Herein, we report a case of distal MCA fusiform thrombosed large aneurysm in which the patient underwent overlapping stent with coil embolization. Case Description: A 28-year-old man presented to our hospital due to sudden headache onset. Computed tomography revealed a subarachnoid hemorrhage and oval lesion with calcification in the left sylvian fissure. Digital subtraction angiography revealed an 8-mm fusiform aneurysm in the M2 and M3 segments of the left MCA. We performed palliative coil embolization of the saccular portion of the aneurysm. The patient was discharged 22 days after presentation. Imaging performed 2 months after the initial treatment revealed aneurysm enlargement. Because the patient refused to undergo craniotomy, we performed coil embolization with an overlapping stent. An Enterprise 2 stent was deployed to sufficiently cover the aneurysmal segment. Subsequently, an low-profile visualized intraluminal support junior (LVIS Jr.) stent was placed inside the Enterprise 2 stent, and additional coil embolization was performed. Follow-up imaging 5 months after the second treatment revealed complete resolution of the aneurysm. Conclusion: The LVIS Jr.-within-Enterprise 2 stent technique may resolve fusiform aneurysms located in distal arteries and maintain parent artery patency.