This is a case of a man in his 30s with a history of polysubstance abuse who experienced several days of intense headache with nausea and vomiting. CT Head did not demonstrate any subarachnoid hemorrhage. CTA demonstrated the large pseudoaneurysm visualized below.

An angiogram was obtained demonstrating the following findings:

The aneurysm measures approximately 15.1mm in greatest transverse dimension x 15.8mm in
height with a 9.3mm neck.

This case was treated using dual access from the right radial artery and right femoral artery. A 6F RIST catheter was first advanced to the right subclavian artery and a 6F Pilote sheath was advanced through the femoral access to the left vertebral artery. A CAT 5 intermediate catheter was advanced into the distal left vertebral artery and an XT-27 microcatheter was advanced through the left vertebral artery to the right PCA. After this, an Echelon 10 45 deg microcatheter was used to access the dome of the aneurysm through the RIST catheter.

A Surpass Evolve 3.25 mm x 25 mm Flow diverting stent was then deployed from the distal basilar artery across the neck of the aneurysm into the left distal V4 vertebral artery. The following coils were then deployed into the aneurysm:

Target XL 360 soft 14 mm x 50 cm
Target XL 360 soft 12 mm x 45 cm (3)
Target XL 360 soft 6 mm x 20 cm
Target XL 360 soft 5 mm x 15 cm

The patient was placed on Aspirin 81mg and Ticagrelor 90mg BID and has been doing well since discharge without further neurological deficits but will need close interval follow-up.