Article Text

Download PDFPDF
Original research
Transcirculation approach for stent-assisted coiling of intracranial aneurysms: a multicenter study
  1. Justin R Mascitelli1,
  2. Michael R Levitt2,
  3. Christoph J Griessenauer3,4,
  4. Louis J Kim2,
  5. Bradley Gross5,
  6. Adib Abla6,
  7. Ethan Winkler6,
  8. Brian Jankowitz7,
  9. Ramesh Grandhi8,
  10. Oded Goren3,
  11. Clemens M Schirmer3,4
  1. 1 Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
  2. 2 Department of Neurosurgery, University of Washington School of Medicine, Seattle, WA, USA
  3. 3 Department of Neurosurgery, Geisinger Health System, Danville, PA, USA
  4. 4 Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
  5. 5 Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
  6. 6 Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
  7. 7 Department of Neurosurgery, Cooper University Health Care, Camden, NJ, USA
  8. 8 Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
  1. Correspondence to Dr Justin R Mascitelli, Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA; jmascite{at}


Background The transcirculation approach (TCA) for stent-assisted coiling (SAC) of intracranial aneurysms may be useful for certain wide-neck bifurcation aneurysms as well as those with acute-angle efferent branches.

Objective To describe a multicenter experience using the TCA for SAC.

Methods A multicenter, retrospective study (2016–2020) of aneurysm treatment using SAC via the TCA. Angiographic outcome was scored using the Raymond Scale (adequate occlusion 1 and 2), and clinical outcome was scored using a modified Rankin Scale (good outcome 0–2)

Results Twenty-nine patients with 29 aneurysms were included (62.1% female; average age 61; 89.7% unruptured; 13.8% previously treated; average dome size 6.4 mm; average neck 4.4 mm). Aneurysm locations included internal carotid artery–fetal posterior cerebral artery (n=4), internal carotid artery terminus (n=4), anterior communicating artery (n=8), vertebral artery–posterior inferior cerebellar artery (n=2), and basilar tip (n=11). The TCA used communicating arteries (93.1%; average 1.6 mm), intermediate catheters (51.7%), jailing technique (62.1%), and staged procedures (10.3%). The most common stent was the Neuroform Atlas (Stryker; 69%). Immediate adequate occlusion was obtained in 75.9%, and five patients with inadequate occlusion progressed to adequate occlusion at follow-up. One (3.4%) procedural complication occurred: a watershed stroke in the setting of baseline four-vessel extracranial disease. Two patients had a poor outcome unrelated to the TCA. The majority of patients (86.4%) had a good clinical outcome. One case of in-stent stenosis due to non-compliance with medication was seen, which resolved with medication resumption.

Conclusions The TCA for SAC can be performed for a variety of aneurysms with a low complication rate and good clinical outcomes.

  • aneurysm
  • stent
  • technique
  • coil

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter @DrMichaelLevitt, @cgriessenauer

  • Contributors All authors participated in data collection. JRM drafted the manuscript. All authors participated in manuscript review and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JRM: Compensated for lectures for Penumbra and PMI. MRL: Educational grants from Stryke, Medtronic, Philips volcano; equity interest in Synchron, Cerebrotech, Eloupes; adviser for Metis Innovative; consultant for Medtronic. CJG: Consultant to Stryker; research funding from Medtronic. LJK: Stock ownership, Spi Surgical, LLC. BG: Consultant for Medtronic and MicroVention. AA: Consultant for Stryker. BJ: Consultant for Stryker, Medtronic. RG: Consultant to BALT Neurovascular, Medtronic, Cerenovus. CMS: Research support: Penumbra; ownership; Neurotechnology investors.

  • Provenance and peer review Not commissioned; externally peer reviewed.