A steerable microcatheter–stabilizer strategy for stent-assisted coiling of a wide-neck middle cerebral artery aneurysm with an acutely angulated incorporated branch

Background: Wide-neck middle cerebral artery (MCA) aneurysms incorporating acutely angulated branches remain among the most technically challenging lesions in neuroendovascular therapy. Selective branch catheterization and subsequent catheter exchange may be difficult using conventional techniques. Methods: A 79-year-old man with an enlarging unruptured right MCA aneurysm underwent stent-assisted coil embolization. A 2.0-Fr SwiftNINJA (LEONIS Mova Selective, Merit Medical/SB-Kawasumi Laboratories, Kanagawa, Japan) steerable microcatheter was used to achieve distal access to the incorporated branch through active tip deflection and angle locking. After distal access had been secured, a Stabilizer device (The Medilizer Anchor Guiding Device; Bolt Medical, Carlsbad, CA, USA) was deployed to facilitate catheter exchange to a stent-delivery microcatheter. Results: The incorporated branch was successfully catheterized despite severe angulation. Distal anchoring with the Stabilizer device enabled safe catheter exchange, followed by successful deployment of a Neuroform Atlas stent (Stryker Neurovascular, Kalamazoo, MI, USA) and subsequent coil embolization. Complete aneurysm occlusion was achieved while preserving the incorporated branch, and no procedural complications occurred. Conclusion: This technical note describes a stepwise steerable microcatheter–stabilizer strategy that addresses two major procedural challenges – branch access and catheter exchange. The technique may represent a useful option for selected aneurysms requiring branch preservation and complex endovascular navigation.