Endovascular coil occlusion of a giant serpentine aneurysm

Patient presentation

• A 51-years-old male patient
• Headache
• Mild right hemiparesis (4/5 MRC)
• History of a diagnosed but untreated GSA arising from fetal PCA

MRI, 2015, a partial thrombosed GSA, neurologically intact

DSA, 2015

• The patient was offered follow-up by a different team

CT, MRI, 2021

• Mesencephalon compression and perilesional edema

DSA, 2021

• GSA arising from fetal PCA

Treatment Plan: Coil Occlusion

• 6 Fr Neurobridge 52 catheter 125 cm (Acandis, Pforzheim, Germany)
• 1.9 Fr microcatheter (APT Medical, Shenzhen, China)
• Hybrid micro guidewire (0.014 inches, Balt, CA, USA)
• Coils (Barricade Complex Frame, Balt, CA, USA)

Intraoperative images

• Long sheath
  * PcomA catheterization

PcomA catheterization

Post embolization

Peoperative period was uneventful; CT

6th-month follow-up MRI

• Mesencephalon compression and edema decreased
• Hemiparesis improved (5/5 MRC)

6th-month follow-up DSA

• Stable coil package and no aneurysm