Non-visualizable stent-occlusion after treatment of a fusiform PCA-aneurysm–a case report

We report the case of a 17-year-old woman with extensive subarachnoidal hemorrhage due to a ruptured fusiform aneurysm of the right PCA (posterior cerebral artery). Endovascular treatment was successfully performed using a LVIS-EVO-Stent (Microvention Incorporation, Tustin, USA) as well as several coils. Short-term angiographic follow-up demonstrated extensive aneurysm progression and dilatation of the coil package, the stent could no longer be visualized and was not passable. Despite excellent distal vascular perfusion, a non-visible stent occlusion was suspected and subsequent occlusion of the patent artery was performed. We conclude that rapid progression of fusiform aneurysms after stent-assisted coiling may lead to expansion of the coil packages and non-assessability of the stent. Even with excellent distal perfusion, a stent-occlusion should be suspected in these cases. Therefore, we suggest short-term angiographic follow-up, especially after deploying multiple coil packages in fusiform aneurysms.