Neuroform Atlas stent-assisted coiling using the herniation technique for wide-necked posterior communicating artery aneurysms with a fetal posterior cerebral artery

Background Endovascular treatment of wide-necked posterior communicating artery (PCoA) aneurysms associated with a fetal posterior cerebral artery (fPCA) remains a challenge. This study evaluates the safety and efficacy of Neuroform Atlas stent-assisted coil embolization using the herniation technique for wide-necked PCoA aneurysms associated with a fPCA. Methods We retrospectively analyzed 19 patients with wide-necked PCoA aneurysms and fPCA who had undergone Neuroform Atlas stent-assisted coil embolization using the herniation technique in the Department of Neurosurgery at Jingmen Central Hospital between January 2022 and December 2024. Digital subtraction angiography (DSA) was performed immediately post-procedure and at 3–6 months of follow-up. Aneurysm occlusion was assessed using the modified Raymond classification, and clinical outcomes were measured with the modified Rankin Scale (mRS). Results All procedures were successfully completed without intraoperative complications. One patient experienced a delayed thrombotic event postoperatively, and another died of multiple organ failure. Immediate postoperative DSA showed modified Raymond grade I in 13 cases (68.4%), grade II in one case (5.3%), grade IIIa in two cases (10.5%), and grade IIIb in three cases (15.8%). Among the 18 surviving patients, all achieved an mRS score of 0 at the 6-month follow-up. Among the 15 patients who had a DSA follow-up (median 7 months, range 3–26 months), aneurysm occlusion was modified Raymond grade I in 12 cases (80.0%), grade II in one case (6.7%), and grade IIIa in two cases (13.3%). PCoA patency was preserved in all patients without in-stent restenosis. Conclusion Our study preliminarily suggests that the herniation technique with the Neuroform Atlas stent appears feasible and effective for wide-necked PCoA aneurysms with fPCA, with favorable occlusion and PCoA preservation. Further large-scale, prospective, and stratified studies with extended follow-up are required to validate these findings.