Treatment of an Intracranial Fusiform Vertebral Aneurysm Using the MVP® Micro Vascular Plug System as an Adjunct to Pipeline(TM) Embolization: Technical Case Instruction.

ABSTRACT

Fusiform and dolichoectatic aneurysms pose unique challenges in treatment, often requiring alternative approaches compared to saccular aneurysms. Microsurgical options like clipping or a bypass can be difficult, leading to the advancement of endovascular techniques. Flow-diverting stents and vessel sacrifice with detachable coils have shown efficacy in reconstruction. The MVP® Micro Vascular Plug System (Medtronic, Minneapolis, Minnesota, USA) offers a resheathable plug for vessel occlusion through electrolytic detachment. This case report illustrates the supplementary application of MVP® subsequent to flow diverter (FD) stenting, resulting in the effective endovascular management of a fusiform aneurysm affecting both vertebral arteries (VA), following unsuccessful coil vessel sacrifice treatment. A 61-year-old female presented with an unruptured fusiform aneurysm in the bilateral vertebral arteries (VAs). Treatment included a flow diverter in the right VA and vessel sacrifice in the left VA using Onyx-18 and coils. Despite initial success, left V4 segment recanalization occurred. Endovascular treatment, deploying two devices and additional coils using the MVP®, halted the flow. Follow-up showed left VA occlusion and reconstruction of the treated right VA, with the patient being discharged without deficits. This case demonstrates a unique approach using MVP® alongside a flow diverter (a PipelineTM Embolization Device (PED), Medtronic) for the treatment of a V4 segment fusiform aneurysm. This innovative technique is an alternative when conventional coil embolization for vessel sacrifice fails. The MVP®'s ease of use and precise delivery render it a feasible and efficacious alternative for treating complex aneurysms.