PMC6849334_01
(A) Recanalization of the aneurysmal sac 6 months after the second coiling procedure seen from R ICA injections in oblique projection. Both ACAs arise from the dominant R A1 segment. (B) Left ICA injection demonstrates hypoplastic L A 1 segment.
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F1
However, the two following consecutives DSAs in 3 and 6 months after the most recent embolization demonstrated a recurrent recanalization at the base of the aneurysm (Figure 1).
(A) The Rebar microcatheter extends from R ICA to the contralateral left A2 segment. (B) The positioning of the distal tip of the microcatheter in the L A2 is confirmed by selective injection. (C) The stent was deployed from the proximal left A2 segment (black arrows pointing at distal markers) to the proximal R A1 segment (white arrows pointing at the proximal markers). (D) Magnified view of the near-completely deployed device. The expanded portion of the device fully conforms to the neck (white and black arrows). The red arrow points to the distal end of the stent positioned at the proximal left A2 segment.
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F2
A2 segment, and the proximal end of the device extended into the proximal R A1 segment (Figure 2). A second microcatheter (Echelon 10) was then delivered over the
Embolization of the recanalized portion of the aneurysm with coils. The bottom images are un-subtracted for better visualization of the stent and coils. (A,B,D) The Barrel VRD is positioned from proximal R A segment (white arrow) to the proximal L A2 segment (black arrow). (E,F) The stent was detached (green arrows), once coiling was completed. (C) Final angiogram in working projection demonstrating complete obliteration of the aneurysm.
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F3
Silver Speed guidewire across the stent into the recanalized portion of the aneurysm. Several Axium Prime coils were deployed until full occlusion of the aneurysm was achieved (Figure 3).