In this article, we report a case of an SAA successfully treated with a double-layer micromesh carotid stent using an endovascular approach and discuss the endovascular management of SAAs in the light of existing literature.

Figure 1. A contrast-enhanced computed tomography angiography showing an aneurysmal dilation in the mid-to-distal segment of the splenic artery, measuring 22×26×24 mm.

The procedure was performed under local anesthesia. Using the Seldinger technique, a 7-Fr intra-arterial sheath was introduced into the right femoral artery. A 0.014-inch guidewire (Hi-Torque Command™ Peripheral Workhorse Guidewires, Abbott Cardiovascular, MN, USA) was advanced into the celiac artery and subsequently into the splenic artery with the assistance of an INVAMED™ support catheter (INVAMED, Ankara, Türkiye). Selective angiography delineated the location of the aneurysm. A stiff wire (ZIPwire, Stiff Type, Boston Scientific, MA, USA) was, then, positioned within the splenic artery and later exchanged for a Hi-Torque Steelcore 18 LT (0.018x300 cm, Workhorse 0.018) to ensure adequate support.

A 7 mm x 30 mm double-layer micromesh carotid stent (Roadsaver®, Terumo, Tokyo, Japan) was deployed across the aneurysm sac. Post-placement angiography demonstrated residual proximal filling of the aneurysm sac, necessitating the deployment of a second stent (8×30 mm) overlapping the first. Subsequent angiography revealed cessation of turbulence and antegrade flow into the aneurysm sac, with only minor retrograde filling observed. The procedure was completed upon removal of the support system and wires. The patient was discharged on the second postoperative day without complications. A follow-up CTA performed one month later confirmed complete aneurysm thrombosis without evidence of endoleak (Figure 2a, b). Following the procedure, the patient was initiated on dual antiplatelet therapy (DAPT; acetylsalicylic acid [ASA] plus clopidogrel). At the end of the first year, the treatment plan was to discontinue clopidogrel and continue antiplatelet therapy with ASA alone. Written informed consent was obtained from the patient.

Figure 2. (a) A follow-up CTA performed one month later confirming a complete thrombosis of the aneurysm without signs of an endoleak. (b) The 3D CTA reconstruction shows the positioning of the implanted stent.
3D CTA: Three-dimensional computed tomography angiography.

In general, three primary treatment modalities exist: open surgery, endovascular interventions, and conservative observation. Historically, open surgical repair was the standard approach, offering durable results but at the cost of significant perioperative morbidity and potential splenectomy. Conversely, conservative management carries a persistent risk of rupture, with reported mortality rates ranging from 10 to 25% in cases of aneurysm rupture.[3-6]

In recent years, endovascular interventions have gained prominence due to their minimally invasive nature and lower short-term complication rates. Among these techniques, coil embolization has been widely utilized, but it carries a substantial risk of splenic infarction, particularly in distal aneurysms, with ischemic complications occurring in approximately 40% of cases.[1,2,5] Stent grafting, in contrast, maintains splenic perfusion while excluding the aneurysm, thereby minimizing ischemic risk. The literature reports splenic infarction in approximately 11% of patients treated with stent grafting.[5]

Despite the increasing use of endovascular therapy for SAAs, reports on the application of stent grafts remain limited. A review by Ouchi et al.[5] identified 27 cases treated with stent grafts, of which 17 cases were further analyzed. Among these, two cases exhibited splenic infarction, while one case experienced stent migration and occlusion. The procedural challenge of navigating stent grafts through the tortuous anatomy of the splenic artery remains a significant limitation.

In the present case, the high tortuosity of the splenic artery precluded the use of conventional covered stents, necessitating the selection of a more flexible device. The stent we used offers practical advantages due to its superior technical features, including enhanced flexibility and vessel wall conformability. The Roadsaver® double-layer micromesh carotid stent was chosen for its adaptability and capacity to facilitate aneurysm thrombosis while preserving arterial patency. The dual-layer structure of the stent provided an effective flow-diversion mechanism, leading to successful aneurysm exclusion.

Recent case reports have documented the use of double-layer micromesh stents in the treatment of renal, visceral, and peripheral artery aneurysms.[6] These reports highlight the technical success of this approach, particularly in complex vascular anatomies. In the present case, complete aneurysm thrombosis and uninterrupted splenic perfusion were confirmed at one-month follow-up, underscoring the efficacy of this technique.

In conclusion, splenic artery aneurysms pose a significant risk of rupture and hemorrhagic complications, necessitating timely intervention when their diameter exceeds 2 cm. The increasing utilization of endovascular techniques, facilitated by technological advancements, has shifted treatment paradigms away from traditional open surgical repair. Double-layer micromesh flow-diverting stents may constitute a favorable endovascular approach, particularly in the management of aneurysms associated with tortuous vascular configurations. Owing to their enhanced flexibility, efficacy in aneurysm exclusion, and maintenance of arterial patency, these devices may offer a superior alternative to traditional covered stents. Nevertheless, further high-quality, large-scale investigations with extended follow-up are warranted to clarify long-term outcomes and to establish evidence-based treatment guidelines for SAAs. Taken together, our case illustrates the practical applicability of this stent and its favorable early-phase adaptability to the vessel, offering preliminary evidence to inform future research.

Data Sharing Statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.

Author Contributions: Conception and design of the research, acquisition of data, analysis and interpretation of the data, Statistical analysis and Obtaining financing, writing of the manuscript: G.A., M.M.K., E.E., A.C; Critical revision of the manuscript for content: G.A., M.M.K., E.E.

Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Funding: The authors received no financial support for the research and/or authorship of this article.

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