Figure 1

Imaging of the aneurysm before (A), during the stenting (B-G) and in vascular rescue procedure (H-J). A) Preoperative angio-CT: Aneurysm of the basilar artery (hollow arrow) and evidence of wide neck (thin arrows). B) to G) First procedure. A balloon-expandable stent (arrowhead in B and thick arrow in C) is advanced on a microguidewire (thin arrows in B). Once the stent was deployed, it slid out of place towards the sac (thick arrows in D). The whole misplaced stent was gently pushed into the sac (thick arrow in E and F) using a balloon mounted on the same microguidewire (thin arrows in E). A second balloon-expandable stent (arrowhead in F) is placed over the entire length of this wide-necked aneurysm (hollow arrow in F). This second balloon-expandable stent is in a correct position within the parent vessel (dotted arrow in G), the first misplaced BES lies within the aneurysm (thick arrow in G) and a sluggish intraaneurysmal vortex motion is clearly shown (hollow arrow in G). Second procedure. Neurological impairment four hours later explained by in-stent thrombosis. An intravascular clot initially emerging from the thrombosing sac (hollow arrow in H) overflows into the basilar artery (dotted arrow in H). Both pharmacological and mechanical measures using a microguidewire (thin arrows in J) successfully recanalize the arterial tree distal to the aneurysm (J). Imaging follow-up. At one week, the T1 magnetic resonance imaging shows a residual stroke in the ventral portion of the cerebral peduncle (dotted arrow in K).