Introduction Selection of proper treatment for cerebral aneurysm is, in general, standardized procedure and depends on experience of neurovascular team and availability of modern technology. However, even in the era of evidence based and risk stratified guidelines there is still opportunity for unusual solution in some cases. Hereby we want to present a number of cases with unusual aneurysm geometry that required non-standardized approach and were treated by means of complex stent assisted coil embolization.

Materials and methods Overall, complex techniques of stent-assistance were implied for 43 patients with 45 aneurysms since March 2013. We assume as ‘uncommon’ the techniques of waffle-cone (n-3), F-stenting (n-2), X-stenting (n-5), transverse BA stenting through pComm (n-3), true pComm stenting (n-2) complex Y stenting (n-1), stent assisted coiling for fusiform aneurysms (n-2) and stent delivery through the lumen of intracranial balloon device (n-25). The aneurysms were located at the ophthalmic artery (n-2), pComm (n-2), ICA bifurcation (n-1) aComm artery (n-15), distal anterior cerebral artery (n-2), middle cerebral artery (n-13), PICA (n-2), SCA (n-1), AICA (n-2), P3 (n-1), BA (n-2).

Results Of 43 aneurysms, 4 (9.3%) patients developed recanalization, 3 of them required FD placement, and 1 was retreated with coils. No rebleeds were observed during follow-up. We observed intraoperative complications in 3 (6.9%) cases, which in two cases led to moderate morbidity and in 1 led to death. Technical issues were observed in 7 (16%) cases, in 5 (11.6%) cases they were solved without consequences and in 2 (4.6%) cases interfered with planned intervention.

Conclusion Low profile intracranial LVIS Jr stent, due to its intrinsic properties, allows for implication of complex embolization techniques in cases otherwise nonaproachable for coil embolization. Morbidity and mortality with those techniques do not exceed literature standard.

Disclosure D. Kislitsin: None. R. Kiselev: None. A. Gorbatykh: None. A. Alshevskaya: None. K. Orlov: None.