Fig. 2.

Treatment of a ruptured ‘blister’ aneurysm in a 68-year-old woman. The aneurysm is located above the origin of a fetal PCA (a, b). A Neuroform stent was deployed across the aneurysm and the PCA origin (c). It was not possible to telescope another Neuroform stent into the first one due to high friction of the microcatheter within the stent. Five hundred milligrams of aspirin was given i.v. after stent deployment. The patient was started on 75 mg of aspirin per day. The patient suffered a rebleed 20 days later. A Vasco microcatheter was advanced into the M1 segment across the Neuroform stent and a SILK flow-diverting stent was partially deployed in the M1 with the intention to pull the open distal end into the Neuroform stent (d). However, due to a significant distal stenosis of the Neuroform stent, which had not been appreciated, the SILK was constrained and fixated in this location (d). It was not possible to retrieve the SILK device. There was immediate clot formation with ICA occlusion. It was subsequently possible to pass the stenosis and perform an angioplasty with a Scepter balloon (e). A total of 20 mg of ReoPro were given i.v.. There was partial recanalization with persistent occlusion of some MCA branches. The transiently occluded ACA and PCA were filling from vertebral and contralateral ICA injections (not shown). In spite of only a small infarct, the patient failed to recover and died 1 week later