This is the case of a young adult, previously medically fit, presenting with acute subarachnoid haemorrhage (Hunt and Hess Grade I).
A cerebral DSA showed a tiny blister from the posteromedial wall of the right internal carotid artery. The aneurysm was so small and the location so unusual that coiling or surgery was not possible in this case.
Hence treatment with flow diversion was decided upon.
We used a single Enterprise stent for this purpose.
Immediate post stent angiogram showed some conformational change in the parent artery as well as some change in the morphology of the aneurysm as well.
The patient was put on dual antiplatelets and advised rest.
After 8 months a check angiogram was done in which the aneurysm was completely excluded from circulation. The parent vessel was fully patent with normal distal perfusion.

Fig 1: RICA injection showing the small aneurysm (arrow)

Fig 2: Immediate post stenting control: the arrowheads point to the stent markers, note the straightening of the ICA and MCA with loss of the curve between the MCA and ICA, the aneurysm has decreased in size and poorly filling now, only a tiny jet on contrast is seen to come out of the stent and fill a small portion of the blister

Fig 3. 8 months follow up image; there is further flow modification resulting in further straightening of the artery, poor flow into the ACA and complete exclusion of the aneurysm.