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Objective: Authors describe our experience of transbrachial coil embolization for posterior circulation aneurysms by using a 4 French (Fr.) guiding sheath. Case Presentations: We retrospectively evaluated the technical feasibility, access site complications, and concomitant use of adjunctive techniques on transbrachial coil embolization from April to July 2015. Results: Three patients underwent transbrachial coil embolization for a posterior circulation aneurysm using a 4 Fr. guiding sheath. The patients’ average age was 78.7 years (range 74–87 years). Two patients had a ruptured aneurysm (two aneurysms), and one had an unruptured aneurysm. The site of the aneurysms included a right vertebral arteryposterior inferior cerebellar artery bifurcation, basilar bifurcation, and basilar artery-left superior cerebellar artery bifurcation. All procedures were successfully performed using the brachial approach and balloon neck remodeling technique. No periprocedural or access site complications were observed. Conclusion: Transbrachial coil embolization of a posterior circulation aneurysm may be a useful alternative method, especially in elderly patients with an undesirable arterial anatomy for a transfemoral approach. Additionally, the 4 Fr. guiding sheath is a useful device for this approach, as it enables the adjunctive techniques and minimizes the brachial puncture size.

Transbrachial Coil Embolization for Posterior Circulation Aneurysm in Elderly Patients Using a 4 Fr. Guiding Sheath