Aneurysm come in all shape and sizes and at all locations.

This one was in a 42 years old female patient with Grade I SAH and a ruptured right PcomA aneurysm.

The anatomy was odd with a bulbous, rather blister like proximal part, then a narrowing, then the body, again a narrowing then a teat like portion. The Pcom, of course, had to arise from the aneurysm; specifically it came at the site of first narrowing mentioned.

The aneurysm was directed laterally and posteriorly and had a curved structure rather.

The proximal bulbous portion measured 2.67 mm in diameter with equal neck and the distal narrower portions 2 mm.

So, I used an Echelon and Xpedion –ten system- to access the aneurysm.

Then i was in a fix as to how to go about fixing the aneurysm.

I put in a 2x6 3D AXIUM in the mid part of the aneurysm beyond the Pcom origin. The coil loops did try to go in the distal teat but somehow the entire coil could be fit in there.

Angio showed complete cessation of flow within that portion, with contrast stasis in the teat and the Pcom stayed patent.

However in the native images, still some space appeared within the coil mesh, so I took an AXIUM 2x4 Helix coil and pushed in.

The loops went into the first coil and then started to come into the proximal portion. Somehow, the loops in this part stayed horizontal thus restructuring the inflow zone and contrast flowing into the pcom.

But the last loop could not be fit in and kept pushing the microcatheter tip into the arterial lumen.

So I left the procedure at that point and put my hands up.

The patient is fine, and we all are happy, but do not know what this anueurysm was ot how best to treat it.

My surgeon too told he would have clipped in the midpart  so the result would have been same, or rather bad as this looked to me like an infundibulum which had ruptured and the distal portion to me was nothing but a pseudoaneurysm.

I am keeping my fingers crossed. let’s see….