Balloon-Assisted Coiling Followed by Half-T or T Stenting of Unruptured Superior Cerebellar Artery Aneurysms

BACKGROUND AND PURPOSE:

Superior cerebellar artery (SUCA) aneurysms are rare and anatomically challenging lesions. Surgical and endovascular approaches are complicated by the vessel’s small diameter, and proximity to eloquent structures. We describe a technique combining balloon-assisted coiling followed by Half-T or Complete T stenting using a braided stent, aiming to achieve high occlusion rates with low complication risk.

MATERIALS AND METHODS:

This retrospective, single-center study included patients with unruptured aneurysms at the origin of the superior cerebellar artery (SUCA) treated between May 2012 and December 2023. All patients underwent balloon-assisted coiling followed by stenting in either a Half-T or Complete T configuration through the remodeling balloon. Clinical and angiographic outcomes, peri-and post-procedural complications, and 12-month follow-up digital subtraction angiography (DSA) were assessed.

RESULTS:

A total of 55 patients were treated. All achieved immediate post-procedural complete occlusion (Raymond-Roy Class I). The overall periprocedural complication rate was 5.5% (n = 3), including two minor-ischemic events and one limited arterial dissection without ischemic consequence; none resulted in clinical deterioration or worsening of the modified Rankin Scale (mRS) score at discharge. No hemorrhagic events were observed. At 12-month follow-up, 94% of patients maintained Class I occlusion. Favorable clinical outcomes (mRS 0–1) were observed in 92% of patients, of whom 98% demonstrated no change in mRS compared to their pre-procedural baseline. Subgroup analysis of patients treated with a Complete T configuration showed comparable safety and efficacy outcomes.

CONCLUSIONS:

Balloon-assisted coiling followed by Half-T or Complete T stenting appears to be a safe and effective method for treating unruptured SUCA aneurysms, achieving high and durable occlusion rates. Limitations include retrospective design, lack of control group, and self-adjudicated results. Further multicenter and core-lab validated studies are warranted. ABBREVIATIONS: SUCA = superior cerebellar artery; BA = basilar artery; PCA = posterior cerebral artery; ACT = activated clotting time; FD = flow diverter.