Bifurcation challenges in unruptured MCA aneurysm

Presented at LINNC Paris 2026 by Rodrigo Rivera and team, this live case examines the complex endovascular treatment of an unruptured broad-neck right MCA bifurcation aneurysm in a 78-year-old female.

Strategic Decision-Making & Procedural Nuances

Due to the incorporation of an acutely angled superior M2 trunk, the team opted for stent-assisted coiling using a braided LVIS EVO stent via a distal radial snuffbox approach.

Key technical highlights and expert panel debates:

Overcoming acute tortuosity: Distal microcatheter shaping, navigating an acute angle, and using an anchoring exchange technique with a stent retriever.
Intraprocedural adaptation: Deploying the stent via a jailing technique, stabilising the sac with coil mass prior to attempted balloon angioplasty, and knowing when to safely halt manipulation to prevent vessel injury.
Alternative paradigms: In-depth panel discussion evaluating clipping versus endosaccular flow disruption and flow diverters in elderly anatomies.

Managing acute bifurcation challenges in unruptured broad-neck MCA aneurysm

Strategic Decision-Making & Procedural Nuances

Key technical highlights and expert panel debates:

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