Case 6

Abstract

A 66-year-old man initially admitted in 2004 with acutely ruptured right MCA giant aneurysm. (a) NECT shows acute subarachnoid hemorrhage with intraventricular and intraparenchymal extension. There is a well-defined heterogeneous mass lesion in the right Sylvian cistern suggestive of a GIA. Cerebral DSA shows a distal M1 segment GIA with patent bifurcation (star). The patient was initially treated by open surgical reconstruction with a clip. (b) Postsurgical, cross-sectional, and DSA images reveal exclusion of the aneurysm with an ectatic M1 segment. Note the residual hematoma and subarachnoid hemorrhage. (c) Patient presented 10 years later with headaches. Right ICA AP and 3D DSA images reveal right M1 segment fusiform regrowth measuring 23 × 18 mm. (d) On July 2014, the patient was treated using a long FRED® FD measuring 3.5 × 40 × 36 mm in size using looping and anchoring technique. IA VASO CT® depicts intra-aneurysmal FRED® location and displacement of the clip by aneurysmal regrowth. (e) After 3 months, the patient presented with diffuse right-sided headaches. Control DSA and IA VASO CT® reveals total exclusion of GIA from circulation with a stable stent configuration. There is intimal hyperplasia causing high-grade (approximately 95 %) short-segment stenosis involving the stented segment. The patient was treated by balloon angioplasty of the in-stent stenosis. Post balloon angioplasty there was significant improvement in the caliber of the stenotic segment and improved perfusion of the distal territory. (f) After 1.5 years, IV VASO CT® reveals stable aneurysmal occlusion with no intimal hyperplasia