• Raper Daniel M S DMS Department of Neurological Surgery, University of California, San Francisco, California, USA., W Caleb Rutledge, Ethan A Winkler, and Adib A Abla.
• Department of Neurological Surgery, University of California, San Francisco, California, USA.
• World Neurosurg. 2020 Jan 1; 133: 173-177.

BackgroundDespite a variety of technologies that are available for treatment of complex intracranial aneurysms, certain anatomic configurations remain challenging to address endovascularly.Case DescriptionA patient was found to have an incidental 12 mm × 11 mm × 10 mm, wide-necked right posterior communicating artery aneurysm with a fetal origin of the posterior cerebral artery arising directly from the aneurysm dome. After multidisciplinary discussion, a staged endovascular treatment approach was undertaken in 2 stages. First, a Y-stent construct using 2 overlapping Neuroform Atlas stents was placed into the M1 and fetal posterior cerebral artery segments. Two months later, after endothelialization of the stent construct, coil embolization of the aneurysm was performed. The patient tolerated both stages of the procedure well and was discharged the following day in each case. She remained neurologically intact, and at follow-up 5 months later had no evidence of residual or recurrent aneurysm.ConclusionsThis case illustrates a number of important considerations in the management approach for wide-necked intracranial aneurysms.Copyright © 2019 Elsevier Inc. All rights reserved.

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