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. 2020 Jan 31;12(5):512–520. doi: 10.1136/neurintsurg-2019-015506

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© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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(A) A patient with an incidentally detected unruptured basilar apex aneurysm presented for WEB treatment. (B) Immediately after unsheathing a proximal Double Layer (DL) device, the microcatheter was advanced distally into the proximal aspect of the aneurysm. Follow-up digital subtraction angiogram (DSA) demonstrated a small amount of active contrast extravasation from the aneurysm dome. (C) Heparinization was reversed with protamine and a Hyperform 4 mm × 7 mm balloon (Medtronic, Irvine, California, USA) was transiently inflated within the distal basilar artery. (D) Repeat angiography demonstrated resolution of the extravasation. (E) Native DSA performed post-detachment demonstrating the WEB device well compressed in the aneurysm, leading to complete occlusion of the aneurysm without any branch vessel compromise. (F) Post-treatment flat panel cone-beam CT head showing a small amount of contrast extravasation within the interpeduncular cistern. The patient experienced no neurological sequelae from the transient extravasation.