Fig 3.

Nonoccluded blister aneurysm previously treated with stent/coil combination. Patient 5 presented with SAH and a blister aneurysm of the left P1/P0 segment, initially treated with a Solitare stent and coils. All images are subtracted DSA of the left vertebral artery in an anteroposterior transfacial projection. A, A 6-mm fusiform blister-type aneurysm projects inferiorly. Note the dilated basilar trunk. B, An aneurysm secured with coils passes through a nondetected Solitare stent. The black arrowhead designates the nondetached proximal marker of the stent. C, Enlarging fusiform blister aneurysm day 11 after MRA (not shown), performed the same, day demonstrates recurrence of the aneurysm. A PED has been deployed in the left P1 segment, across the aneurysm and into the basilar trunk. A microcatheter is jailed in the sac (small black arrow) precoiling. D, Postcoiling angiogram shows a secured aneurysm and good filling of left posterior cerebral artery. The patient developed vasospasm subsequently, which was treated with balloon angioplasty of the ICA and middle cerebral arteries bilaterally (not shown), and made a good recovery. E, Six-month angiogram shows some body filling contained within the coils. Note that the proximal margin of the PED (small white arrow) is proximal to the proximal marker of the stent (black arrowhead). The distal marker of the stent within the P1/P2 segment junction is also shown (black arrowhead). The patient's clopidogrel was stopped as a consequence of the change, but aspirin was continued. F, Ten-month angiogram shows a stable appearance. No action has been taken thus far, and a follow-up angiogram in 12 months is scheduled because there is a reluctance to overlap the PED in the basilar tip and trunk.