Mid basilar aneurysm treatment with unexpected evolution

• Male patient, previous neurosurgery and irradiation due to craniofaringioma pituitary region, was admitted for TIA.
• Sidewall basilar trunk aneurysm was found.
• It was decided to do INR procedure, with leo baby stent and barricade coils.

• CTA and MRI of pitiuary region.

• Overcurved Echelon 10 was jailed, and SAC was coiled.

• Final control after treatment.

• After the procedure, patient was dicharged home, without any clinical symptoms.
• Few months later, he was admitted to emergency and neuro department due to massive headaches.

• Axial CT:

• Axial CT with contrast:

• Right ICA DSA.

• NO SAH was found but hyperdense forming and dilatation at right cavernous segment of ACI was noted. Not seen in initial studies.

What is the diagnosis / cause? How would you treat?

How did I treat:

• It was deciced to do emergency coiling , and in the second stage placing of flow diverter

He was placed on the double antiagregation therapy , symptoms mainly headache vanished , and MR control and DSA was performed

• He was placed on the double antiagregation therapy, symptoms mainly headache vanished, and MR control and DSA was performed 

• Massive reccurency of aneurysm, placement of flow diverter was performed, DERIVO 6x15mm.

• Contrast stagnation was noticed in venous phase
• Control MR was performed 2 months after showed thrombosis on T2 images, and reduction in size of aneurysm.

• Deviation of right bulbus to the right due to neurosurgery procedure
• Planned DSA on 3m FUP