IntroductionUnfavorable anatomy can preclude embolization of intracranial aneurysms. Transcirculation techniques, in which a catheter is navigated from one side of the brain to the other or from the anterior to the posterior circulation, are alternative pathways for primary or balloon/stent assisted coiling. We report the largest experience in coil embolization of aneurysms using these techniques.MethodsWe prospectively reviewed our collected database from 2006 to 2009 and identified 20 patients who had aneurysms treated with transcirculation techniques.ResultsEight patients had anterior and 12 had posterior circulation aneurysms. Overall, nine patients required stent assisted coiling and 10 required balloon assisted coiling, including two patients treated with a ‘kissing balloon’ technique. Of the 10 patients, two requiring balloon assistance were also treated with stenting at the conclusion of aneurysm coiling. One patient with a left V4 aneurysm was treated with a bilateral vertebral artery (VA) approach. In 14 patients, the anterior communicating and posterior communicating arteries were used as conduits. In six patients, both VA were traversed to treat two V4 aneurysms, two posterior inferior cerebellar artery aneurysms, one basilar apex aneurysm and one basilar trunk aneurysm. Overall, two (10%) permanent complications occurred as a result of treatment: one death and one minor stroke. Complete or near complete (>95%) embolization was achieved in all patients.ConclusionsTrancirculation techniques are effective pathways for embolization of complex aneurysms. Although technically challenging, these techniques are associated with an acceptably low rate of complications when compared with the natural history of the treated lesion.Abstract P-020 Figure 1