Nothing new here.  Just showing a very nice off-label use of Comaneci for treating distal spasm.

SAH

Aneurysm

Clips

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

Left side

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

Inferior division

Extending into distal M1

Superior division

Post.  Clearly improved in the inferior division, a bit better superiorly also

Now for the Anterior Cerebral Territory

More

Post

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.

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