Recurrent Ruptured ICA Bifurcation Stent-Coiling

Presented during LINNC Paris 2026, this live case demonstrates the management of a recurrent ruptured internal carotid artery (ICA) bifurcation aneurysm.

Clinical Presentation & Strategic Decision-Making

The session features a 65-year-old male who initially presented with a severe headache and loss of consciousness due to a ruptured right ICA bifurcation aneurysm in 2024, treated via balloon-assisted coiling (BAC). Despite a second BAC procedure 6 months later, the lesion showed progressive recanalization at the A1 origin, expanding to a 3×3 mm remnant by March 2026. Given the high recurrence risk at this bifurcation and the failure of prior simple coiling, the team opts for stent-assisted coiling to provide durable neck support and reconstruct the parent artery.

Key technical highlights

Access & navigation: Establishing proximal access using an 8F short sheath paired with a 90 cm BMX 96 guide catheter.
Intracranial setup: Navigating the anatomy using a 125 cm SOFIA 6F intermediate catheter, SL-10 and Headway 17 microcatheters, a Scepter XC balloon, and Synchro soft / Traxcess microwires.
Reconstruction & coiling: Deploying a laser-cut Neuroform Atlas stent across the bifurcation neck to secure the vessel architecture, followed by targeted embolization using Tetra coils.

Recurrent ruptured ICA bifurcation aneurysm

Live Case Transmission from St Michael's Hospital, Toronto, Canada

Clinical Presentation & Strategic Decision-Making

Key technical highlights

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