At St. Michael’s Hospital (Toronto), a 56-year-old woman was retreated for a residual paraclinoid aneurysm three months after initial treatment with flow diversion and coiling. Using high-resolution nOCT imaging (Spryte), the team placed a second Surpass Evolve stent via femoral access. nOCT enabled visualization of stent apposition and neointimal thickening, guiding decision-making. Follow-up confirmed complete aneurysm occlusion at 18 months.