Nothing new here. Just showing a very nice off-label use of Comaneci for treating distal spasm.
Spasm — this is the good side. Day 10
Bad side — notice hole in inferior parietal and posterior temporal lobes already
Minimal support from the less than ideal vertebrobasilar system
IA verapamil and compliant 3×10 Transform balloon angioplasty. We favor compliant balloons for this — very carefully.
Did proximal M2, M1, and carotid. Post is not bad
We did not feel too good about using balloon in either M2 or the ACA here. Hence Comaneci Petit. Goes through SL-10 in this case or equivalent. Highly navigable. Variable expansion / diameter capability. In many ways this is great off-label use
Extending into distal M1
Post. Clearly improved in the inferior division, a bit better superiorly also
Now for the Anterior Cerebral Territory
Vertebrobasilar did great with IA verapamil alone. Notice two variants — fenestrated basilar and duplicated right AICAs — the lower one is an AICA-PICA, as is usually the case. Upper one is the “real” AICA, with its hemispheric territory usurped by the lower AICA-PICA. See “Primitive Lateral Basivertebral Anastomosis” case also
Do we need to do this at all? Maybe yes, maybe no. In this case, we felt we sure did.