Stent‐Assisted Coiling for Internal Carotid Artery Terminus Aneurysms: A Case Series

Introduction Internal carotid artery (ICA) terminus aneurysms represent a technically challenging subset of bifurcation aneurysms. The role of stent‐assisted coiling (SAC) in this location remains underreported. We present a single‐center case series of 16 patients with ICA terminus aneurysms treated with SAC, analyzing anatomical subtypes, procedural strategies, and angiographic outcomes. Methods We retrospectively reviewed patients treated between 2014‐2025. Patient demographics, aneurysm morphology, procedural details, complications, and follow‐up imaging were assessed. Aneurysms were classified into four anatomical types. Stents were deployed from either M1‐ICA or A1‐ICA depending on vessel size and accessibility. Immediate and follow‐up occlusion status was graded using the Raymond‐Roy Occlusion Classification (RROC). Clinical outcomes were evaluated with the modified Rankin Scale (mRS). Results Sixteen patients (mean age 59.6 years, range 27‐84; 8 males, 8 females) were included. Hypertension and hyperlipidemia were each present in 56.3%, and 56.3% had a prior aneurysm. Mean aneurysm diameter was 6.7 mm (range 1.9‐28.6 mm). Aneurysm subtypes included 9 type 1, 5 type 2A, 1 type 2B, and 1 type 3 (giant) (Fig 1). SAC was performed via femoral access in 9 and radial in 7 patients, with stent deployment most frequently from M1‐ICA (81%) (Fig 2). Two patients presented with ruptured aneurysms, and four developed recurrences during follow‐up. One intraprocedural complication occurred. At final angiographic follow‐up, complete occlusion (Raymond I) was achieved in 78.6% of patients, compared to 56.2% immediately post‐procedure, reflecting durable improvement over time. At last follow‐up, the majority of patients achieved good functional outcomes. Conclusion SAC is a feasible and effective treatment for ICA terminus aneurysms across different anatomical subtypes, achieving durable occlusion with low morbidity. M1‐ICA stent deployment was most common and technically favorable. Despite occasional recurrence and rupture presentations, follow‐up outcomes were favorable. Larger multicenter studies are warranted.