A 42-year-old man with no past significant medical illness presented with headache. CT scan done showed subarachnoid hemorrhage (SAH) predominantly in the perimesencephalic cisterns []. Magnetic resonance imaging T1 gradient sequence also showed the hypointense signal suggestive of blood products in the perimesencephalic cisterns []. Fetal posterior cerebral arteries are seen on both the sides arising from the internal carotid artery [Figures and ]. DSA (digital subtraction angiogram) done subsequently revealed fusiform bulbous dilation involving both the cisternal and cortical segments of the left SCA []. Endovascular treatment in the form of parent artery occlusion was done under general anesthesia, with complete exclusion of the aneurysm from the circulation as seen on post-coiling angiogram []. Standard heparin protocol was followed and activated clotting time greater than 250 s was maintained during the procedure. Six-French (6F) Envoy (cordis) guiding catheter was placed in the distal vertebral artery. A combination of echelon-10 microcatheter (ev3) and transcend 0.014 microwire (Stryker) were used to access the aneurysms. Multiple Axium (ev3) coils were used to occlude the aneurysm. There were no intra- and periprocedural complications and patient was discharged on the 5th day after operation. The post-operative course was uneventful. The patient's neurological examination after 1 month was completely normal. Control angiogram done after 1 year showed stable occlusion of the aneurysm with endovascular coil in place [].
A 50-year-old lady, who had a history of hypertension, presented with severe headache and ataxia. CT scan done at admission showed acute right cerebellar hematoma []. DSA done subsequently revealed fusiform aneurysm of the cisternal segment of the SCA []. Endovascular treatment was done under general anesthesia with inside out coiling of the aneurysm with platinum coils []. Standard heparin protocol was followed and an activated clotting time greater than 250 s was maintained during the procedure. 5F Envoy (cordis) guiding catheter was placed in the distal vertebral artery. A combination of echelon-10 micro-catheter (ev3) and transcend 0.014 micro-wire (Stryker) were used to access the aneurysms and multiple axiom (ev3) coils were used to occlude the aneurysm. Post-coiling angiogram showed complete exclusion of the aneurysm from the circulation. The post-operative period was uneventful. The patient's neurological examination done after 1 month was completely normal. Control angiogram done at the end of 1 year showed stable occlusion with no re-canalization of the aneurysm [].