1104 J. Neurosurg. / Volume 108 / June 2008 OSTERIOR circulation aneurysms represent only 4– 10% of intracranial aneurysms. 5,47,81 Such lesions include wide-neck, fusiform, and dissecting aneu- rysms. 22,31,52 For many years, surgical aneurysm clip place- ment has been regarded as the only effective and definitive treatment available for intracranial aneurysms. Treatment of posterior circulation aneurysms, however, is challenging in neurovascular surgery for many reasons. Some of these aneurysms are of complex morphology (such as fusiform, wide-neck, or calcified), are surgically difficult to ap- proach, or require challenging or risky techniques (such as parent vessel occlusion, skull base approaches, or bypass arterial grafting). It is a matter of consequence that the sur- gical treatment of these lesions involves high morbidity and mortality rates, and perforating vessels are sometimes oc- cluded. 59,71,82 Since the approval of GDCs for the treatment of intra- cranial aneurysms, endovascular techniques have become widely accepted and represent the first choice of treatment in some centers, yielding excellent results that are compa- rable or superior to results from surgery. 8,19,78 The morpho- logical features of some intracranial aneurysms hamper the endovascular approach to such lesions because the coils may protrude into the vessel lumen, and accordingly the J Neurosurg 108:1104–1118, 2008 Use of the sole stenting technique for the management of aneurysms in the posterior circulation in a prospective series of 20 patients MARCO ANTONIO ZENTENO, M.D., 1,3,7 JORGE ARTURO SANTOS-FRANCO, M.D., 1 JOSE MARIA FREITAS-MODENESI, M.D., 5 CAMILO GÓMEZ, M.D., 6 LUIS MURILLO-BONILLA, M.D., M.SC., 4 YOLANDA ABURTO-MURRIETA, M.D., 1,3 RICARDO DÍAZ-ROMERO, M.D., M.SC., 1 EDGAR NATHAL, M.D., 2,7 SERGIO GÓMEZ-LLATA, M.D., 2,7 AND ANGEL LEE, M.D. 3 Departments of 1 Neurological Endovascular Therapy and 2 Neurosurgery, Instituto Nacional de Neurología y Neurocirugía, México City; 3 Comprehensive Stroke Center, Hospital Ángeles del Pedregal, México City; 4 Comprehensive Vascular Institute, Hospital Ángeles del Carmen, Guadalajara, México; 5 Department of Interventional Neuroradiology, Hospital Santa Rita, São Paolo, Brazil; 6 Alabama Neurological Institute, Birmingham, Alabama; and 7 Universidad Nacional Autónoma de México, México City, México Object. The use of intracranial stents in stent-assisted coil embolization is now a current neurosurgical practice worldwide. The clinical utility of these stents in the sole stenting (SS) technique, however, has not been thoroughly de- scribed, and the published reports of this experience are scarce. This study was designed to evaluate SS treatment of dissecting and nondissecting aneurysms of the posterior circulation. Methods. This prospective and descriptive study was conducted in 20 consecutive patients who harbored single an- eurysms of the posterior circulation and who were treated using the SS approach in the last 3 years. The clinical and ra- diological assessment and follow-up of the patients were evaluated using the modified Rankin scale as well as with computed tomography angiography and digital subtraction angiography at discharge and at 1, 3, 6, and 12 months. Results. Eleven of the 20 patients had subarachnoid hemorrhages, 3 presented with ischemia, 1 presented with brain- stem compression, and the remaining 5 patients had incidentally discovered, asymptomatic lesions. Only 1 patient had a complication (occipital infarction) attributable to the SS procedure. One patient died of rebleeding 2 weeks after the procedure. At 1 month, 40% of the patients had a subtotal or total occlusion, which increased to 55% at 3 months and 85% at 6 months, with a final subtotal or total occlusion rate of 80% at 1 year. The SS procedure in 1 case was consid- ered a failure at 6 months because no change had been noted since the 1-month follow-up. One case showed partial oc- clusion and 1 case showed recanalization. Conclusions. Use of SS for aneurysms in the posterior circulation complex is a safe and effective technique, demon- strating an occlusion rate of 80% at the 1-year follow up. (DOI: 10.3171/JNS/2008/108/6/1104) KEY WORDS • dissecting aneurysm • endovascular management • posterior circulation • sole stenting P Abbreviations used in this paper: BA = basilar artery; BES = bal- loon-expandable stent; CSF = cerebrospinal fluid; CT = computed tomography; DS = digital subtraction; GDC = Guglielmi detachable coil; MR = magnetic resonance; mRS = modified Rankin scale; PCA = posterior cerebral artery; PICA = posterior inferior cerebel- lar artery; SAH = subarachnoid hemorrhage; SCA = superior cere- bellar artery; SES = self-expandable stent; SS = sole stenting; VA = vertebral artery; VBJ = vertebrobasilar junction. See the Editorial and the Response in this issue, pp 1101–1103.