PMC6479147_01
A) Wide-necked left middle cerebral artery aneurysm before embolisation; pCONus is positioned at the neck. B) Immediate angiographic control after first embolisation shows a remnant aneurysm with contrast agent inside the sac. C) Angiography after 13 months shows compression of coils and recanalisation of an aneurysm. D) Immediate angiographic control after second embolisation - the dome of an aneurysm filled with an additional 7 coils. E) Arteriography after 16 months (second SAH) shows once again the coil compression with recanalisation of an aneurysm. F) Immediate angiographic control after third embolisation with 7 additional coils - complete exclusion of the dome with the neck remnant
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Because of the large neck and M2 branches arising from the dome of an aneurysm posing a risk of coil protrusion, the pCONus 4-20-10-F stent (Phenox) was positioned and detachable coils were implanted into the aneurysmal dome (Figures 1A, B). The urgent DSA revealed enlargement and recanalisation of the LMCA aneurysm with coil compression compared to the previous examination (Figure 1C). The remnant part of the aneurysm sac was 9 x 12 mm (Figure 1E). Embolisation of the LMCA aneurysm was performed immediately with detachable coils, achieving a similar result to the previous procedure, with a complete exclusion of the dome with the neck remnant (Figures 1F and 2).
Comparison of size of left middle cerebral artery (LMCA) aneurysm before first and after last embolisation. A) Wide-necked LMCA aneurysm before embolisation (22.73 x 22.40 mm). B) LMCA aneurysm after last embolisation (28.17 x 27.04 mm). Significant difference in size of the aneurysm is visible
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Embolisation of the LMCA aneurysm was performed immediately with detachable coils, achieving a similar result to the previous procedure, with a complete exclusion of the dome with the neck remnant (Figures 1F and 2).