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 64-year-old man, who had a history of hypertension, presented with headache and vomiting. CT scan showed SAH in the superior cerebellar cisterns []. DSA done revealed a fusiform aneurysm of the distal SCA, predominantly involving the branch of the cortical segment [Figures and ]. 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 inserted in the distal vertebral artery. The aneurysm was accessed with a combination of micro-catheter (echelon-10) and micro-wire (traxcess12). Meticulous pre-shaping of the micro-catheter according to the shape of the target aneurysm aided in proper positioning of the micro-catheter in the aneurysm which was subsequently packed densely with the platinum micro-coils. Post-procedure angiogram showed complete exclusion of the aneurysm along with the branch of the cortical segment and preservation of the flow in the superior cerebellar artery (SCA) []. There were no untoward events in the post-procedure hospital stay and patient was discharged after 1 week. No neurological deficit was seen during the clinical follow-up after 1 month. Control angiogram carried out after 1 year showed stable occlusion of the aneurysm with preservation of the ante-grade flow in the SCA [].