A 16 years young man with a history of minor head injury a year back and left sided PCA territory infarct 6 months ago underwent DSA revealing a dissecting aneurysm of the V4 segment of left vertebral artery just as it became intradural. He underwent stent assisted coiling. During procedure sudden spasm was noted as soon as the stent was opened (Image D) and the subsequent images (E to H) show relief after infusing nimodipine. Following achieving appearance similar to the control angiogram (Image A) coiling and complete occlusion of the aneurysm was done. The post procedure angiogram shows complete patency of the vertebral artery.

Stent induced spasm is a very rare entity and has to be differentiated the more commoner thrombosis. In this case only nimodipine can revert the artery back to its previous anatomy.

A 32 year old otherwise healthy man came with uncontrolled seizures and mild right sided weakness with a large vascular malformation in the left temporo-occipital region.

He was embolised with Onyx.

The immediate post embolisaion CT was fairly encouraging.

However he suddenly developed seizures and right sided weakness 4 hours later. An urgent CT showed hematoma and IVH.

The hematoma was evacuated immediately. An MRI and DSA done in follow up show good result. The patient had only mild deficit not significantly changed since his pre-embolisation state.

A 35 years old female patient came with sudden onset of headache, diplopia, nystagmus, right sided weakness and gait disturbances.

MRI showed signal change in pons and left middle cerebellar peduncle and a heterogenous mass inseparable from the basilar artery in the prepontine cistern…hematoma

A DSA was done which revealed a dissecting aneurysm from the mid-basilar artery jutting to the left side.

Embolisation of the aneurysm was done with GDC coils. The basilar artery was also occluded. All the major braches proximal and distal to the arterial occlusion were filling adequately.