{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T18:19:17Z","timestamp":1757614757288,"version":"3.44.0"},"reference-count":9,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\nBackground: <\/jats:title>\nAneurysms distal to the M2 segment account for 2\u20137% of middle cerebral artery (MCA) aneurysms. These aneurysms, which are often small and fusiform, have thin walls and are prone to bleeding. Therefore, neck clipping and aneurysmal coil embolization are difficult to perform. Herein, we report a case of distal MCA fusiform thrombosed large aneurysm in which the patient underwent overlapping stent with coil embolization.<\/jats:p>\n<\/jats:sec>\n\nCase Description: <\/jats:title>\nA 28-year-old man presented to our hospital due to sudden headache onset. Computed tomography revealed a subarachnoid hemorrhage and oval lesion with calcification in the left sylvian fissure. Digital subtraction angiography revealed an 8-mm fusiform aneurysm in the M2 and M3 segments of the left MCA. We performed palliative coil embolization of the saccular portion of the aneurysm. The patient was discharged 22 days after presentation. Imaging performed 2 months after the initial treatment revealed aneurysm enlargement. Because the patient refused to undergo craniotomy, we performed coil embolization with an overlapping stent. An Enterprise 2 stent was deployed to sufficiently cover the aneurysmal segment. Subsequently, an low-profile visualized intraluminal support junior (LVIS Jr.) stent was placed inside the Enterprise 2 stent, and additional coil embolization was performed. Follow-up imaging 5 months after the second treatment revealed complete resolution of the aneurysm.<\/jats:p>\n<\/jats:sec>\n\nConclusion: <\/jats:title>\nThe LVIS Jr.-within-Enterprise 2 stent technique may resolve fusiform aneurysms located in distal arteries and maintain parent artery patency.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_717_2025","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T09:09:53Z","timestamp":1757063393000},"page":"379","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Low-profile visualized intraluminal support junior-within-enterprise 2 stent technique for a distal middle cerebral artery fusiform aneurysm: A case report"],"prefix":"10.25259","volume":"16","author":[{"given":"Tomohiro","family":"Matsuda","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Tokushima Prefectural Miyoshi Hospital, Miyoshi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mami","family":"Hanaoka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tokushima Red Cross Hospital, Komatsushima, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeshi","family":"Miyamoto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tokushima University Graduate School of Biomedical Science, Tokushima, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noriya","family":"Enomoto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tokushima University Graduate School of Biomedical Science, Tokushima, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hitoshi","family":"Niki","sequence":"additional","affiliation":[{"name":"Department of Neurology, Tokushima Red Cross Hospital, Komatsushima, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuhito","family":"Matsuzaki","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tokushima Red Cross Hospital, Komatsushima, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koichi","family":"Satoh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yoshinogawa Hospital, Itano, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasushi","family":"Takagi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tokushima University Graduate School of Biomedical Science, Tokushima, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2025,9,5]]},"reference":[{"key":"10.25259\/SNI_717_2025\/ref-1","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1177\/15910199211025109","article-title":"LVIS-within-enterprise double-stent procedure without coiling beneficial as treatment of unruptured vertebral artery dissecting aneurysms","volume":"28","author":"Choi","year":"2022","journal-title":"Interv Neuroradiol"},{"key":"10.25259\/SNI_717_2025\/ref-2","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1136\/neurintsurg-2020-016790","article-title":"Long-term safety and efficacy of distal aneurysm treatment with flow diversion in the M2 segment of the middle cerebral artery and beyond","volume":"13","author":"Cimflova","year":"2021","journal-title":"J Neurointerv Surg"},{"key":"10.25259\/SNI_717_2025\/ref-3","doi-asserted-by":"crossref","first-page":"37","DOI":"10.7461\/jcen.2023.E2023.06.005","article-title":"Microsurgical treatment of distal middle cerebral artery aneurysm: A single-center review","volume":"26","author":"Jang","year":"2024","journal-title":"J Cerebrovasc Endovasc Neurosurg"},{"key":"10.25259\/SNI_717_2025\/ref-4","doi-asserted-by":"crossref","first-page":"965","DOI":"10.3174\/ajnr.A2857","article-title":"Reconstructive endovascular treatment of fusiform or ultrawide-neck circumferential aneurysms with multiple overlapping enterprise stents and coiling","volume":"33","author":"Jeon","year":"2012","journal-title":"AJNR Am J Neuroradiol"},{"key":"10.25259\/SNI_717_2025\/ref-5","doi-asserted-by":"crossref","first-page":"398","DOI":"10.3171\/2013.10.JNS13738","article-title":"Bypass surgery for complex middle cerebral artery aneurysms: Impact of the exact location in the MCA tree","volume":"120","author":"Kivipelto","year":"2014","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_717_2025\/ref-6","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1007\/s00701-015-2666-3","article-title":"In vitro experiments of vessel wall apposition between the enterprise and enterprise 2 stents for treatment of cerebral aneurysms","volume":"158","author":"Kono","year":"2016","journal-title":"Acta Neurochir (Wien)"},{"key":"10.25259\/SNI_717_2025\/ref-7","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.wneu.2018.06.029","article-title":"Flow diversion via LVIS blue stent within enterprise stent in patients with vertebral artery dissecting aneurysm","volume":"117","author":"Lim","year":"2018","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_717_2025\/ref-8","doi-asserted-by":"crossref","first-page":"1959","DOI":"10.3174\/ajnr.A5332","article-title":"Multicenter experience with FRED Jr flow re-direction endoluminal device for intracranial aneurysms in small arteries","volume":"38","author":"M\u00f6hlenbruch","year":"2017","journal-title":"AJNR Am J Neuroradiol"},{"key":"10.25259\/SNI_717_2025\/ref-9","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1227\/01.NEU.0000311255.74837.4D","article-title":"Treatment of giant middle cerebral artery aneurysms with a flow replacement bypass using the excimer laser-assisted nonocclusive anastomosis technique","volume":"63","author":"Van Doormaal","year":"2008","journal-title":"Neurosurgery"}],"container-title":["Surgical Neurology 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