Ruptured dissecting aneurysm treated on day 0 with Pipeline-Shield and coils on aspirin only

47M WFNS 1 SAH. A2 fusiform dissecting aneurysm measuring 3 x 14 mm.

EVD pre-operatively. Aneurysm treated SAH day 0.

Infinity to left ICA. Sofia 6 to left A1. Headway 27 across aneurysm with PED brought into position. Headway Duo to aneurysm with a few coil loops deployed. Aspirin 500 mg IV given. PED-Shield 2.75 x 18 mm deployed across aneurysm. Coiled to exclusion (Raymond-Roy 1). Patient maintained in aspirin 100 mg od until EVD weaned and removed at SAH Day 7. Ticagrelor commenced SAH day 8. Six months follow-up DSA shows aneurysm secured without complication.

Figure 1 : 3D rotational angiography demonstrating A2 fusiform aneurysm

Figure 2 : Conventional DSA demonstrating A2 fusiform aneurysm - Sofia 6 in A1

Figure 3 : PED-Shield deployed across aneurysm with Headway Duo jailed and aneurysm coiling proceeding

Figure 4 : Final working projection demonstrating Raymond-Roy 1 aneurysm occlusion and reconstruction of the at-risk A2

Figure 5 : Follow-up DSA at 14 weeks post-op demonstrating stable aneurysm cure without complication