case_images: PMC5545776_01
case_images: A 64-year-old woman with a ruptured wide-necked bifurcation aneurysm of the right middle cerebral artery who presented with sudden onset severe headache. Digital subtraction angiography image taken during right internal carotid artery contrast injection showing a wide-necked right middle cerebral artery bifurcation aneurysm (arrow). Note mild irregularity of the distal cervical segment of internal carotid artery due to vasospasm (arrowhead).
case_images: JCIS-7-29-g002.jpg
case_images: PMC5545776_01_JCIS-7-29-g002.jpg
case_images: F1
case_images: Digital subtraction angiography through a right femoral access showed a wide-necked middle cerebral artery bifurcation aneurysm measuring 7.3 mm x 5.8 mm, a neck measuring 4 mm [Figure 1].
case_images: A 64-year-old woman with a ruptured wide-necked bifurcation aneurysm of the right middle cerebral artery who presented with sudden onset severe headache. Intraprocedural digital subtraction angiography during right internal carotid artery injection after deploying the pCONus device showing one petal of the device (arrow) prolapsed out of the aneurysm neck into the inferior division of middle cerebral artery. Inset (a) Magnified image of the aneurysm with the deployed pCONus device, the prolapsed petal shown by arrowhead. Inset (b) Schematic diagram showing approximate outlines of the aneurysm and parent vessels (black outline), the four radiopaque markers of the petals (red lines) and the position of the distal petals and stent which are not radiopaque, hence not visible in angiogram. (blue-colored dashed shapes); the prolapsed petal is indicated by a black arrowhead.
case_images: JCIS-7-29-g003.jpg
case_images: PMC5545776_01_JCIS-7-29-g003.jpg
case_images: F2
case_images: After unsheathing the device, there was prolapse of one of the crown petals into the inferior division of middle cerebral artery [Figure 2].
case_images: A 64-year-old woman with a ruptured wide-necked bifurcation aneurysm of the right middle cerebral artery who presented with sudden onset severe headache. Postprocedural digital subtraction angiography during right carotid artery injection showing minimal filling of the aneurysm, patent middle cerebral artery branches, and prolapse of a coil loop into the middle cerebral artery (arrow).
case_images: JCIS-7-29-g004.jpg
case_images: PMC5545776_01_JCIS-7-29-g004.jpg
case_images: F3
case_images: After the procedure, there was minimal residual filling of an aneurysm, and good flow in the middle cerebral artery and its branches [Figure 3].
case_images: A 64-year-old woman with a ruptured wide-necked bifurcation aneurysm of the right middle cerebral artery who presented with sudden onset severe headache. Digital subtraction angiography during right internal carotid artery contrast injection, performed during the 6th month follow-up visit showing occlusion of aneurysm, persistence of prolapsed coil loop (arrow), and normal flow in the middle cerebral artery and its branches.
case_images: JCIS-7-29-g005.jpg
case_images: PMC5545776_01_JCIS-7-29-g005.jpg
case_images: F4
case_images: There was a complete occlusion on follow-up angiography performed 6 months later, and the dissection in the internal carotid artery had healed without luminal compromise [Figure 4].