This is the case of a middle aged patient with Fisher grade 3, Hunt and Hess grade 2 subarachnoid haemorrhage with a ruptured basilar tip aneurysm. The aneurysm was moderate sized, with a wide neck ~ 7 mm involving both the proximal p1 PCA segments (left more than right), and directed posterosuperiorly. The  Pcoms were seen although not very prominent.

An Enterprise 5.5 x 22 mm stent was passed via a Prowler Select Plus microcatheter across the aneurysm neck into the left PCA with trailing portion kept in the basilar artery. A SL 10 microcatheter was then navigated and placed in the aneurysm fundus. The stent was partially opened (JAILING technique) and coiling done. Good packing of the aneurysm was achieved. Then the stent was fully deployed and left in situ.

The patient had been prepared with 300 mg Aspirin and 300 mg Clopidogrel prior to the procedure and given 5000 U heparin bolus after sheath placement. A single femoral puncture had been done with 6F sheath placement and a 6F Envoy used as guide catheter. A double Y Tuohy Borst hemostatic adapter was used to pass the stent and coil noth through the same guide catheter.

The patient had an uneventful recovery and was discharged in stable condition.

She was advised to have Aspirin 150 mg and Clopidogrel 75 mg once daily for next three months and then Aspirin 150 mg for life.

Fig 1. Frontal and Lateral views of LVA injection

Fig 2. 3D DSA images of LVA injection

Fig 3. Stent placement in the left PCA across the aneurysm neck

Fig 4. Coiling of the aneurysm

Fig 5. The deployed stent and fully coiled aneurysm

Fig 6. Pre and post procedure comparative angiograms