Check out treatment video at bottom of page. Another solution for complex anatomy
Which one ruptured?
4 days later. Spasm treatment is limited by unprotected aneurysms and complicated by iatrogenic left vert dissection, so basilar was plastied thru the smaller right vert
Day 5. Spasm of left side
Post plasty and verapamil
To traverse dissection, use a compliant balloon microcatheter. After passing dissection, inflate balloon to eliminate ledge and allow passage of the larger catheter — Sofia in this case
Now we know which ruptured. Arrow points to small PCOM
One can try to do everything thru a 6F intermediate in vert or basilar. However the angle is much more favorable from PCOM – P1 approach. Plato is a 17 microcatheter from Scientia, it is both highly navigable and stable. Catheterization through the small pcom, further narrowed by spasm, was satisfying eventually.
Dissection looks better too
Video
Lessons — aggressive angioplasty is important in spasm. Its worth investing extra work to get a favorable angle for treatment
