Pipeline is a highly effective tool for Anterior Communicating artery aneurysms, particularly when both A1 and A2 segments are present.  Here is a previously ruptured ACOM, with a residual after clipping.  We believe in complete 100% treatment of ruptured aneurysms (click on links for rerupture cases of incompletely clipped and coiled aneurysms).   The aneurysm here is filled via the left A1.  Radial access is perfectly reasonable for Pipeline of ACOMs or other aneurysms distal to the siphon.  Our standard setup is:

6F radial sheath

6F Envoy

Phenom Plus

Phenom 027

Other catheters can be used as well.  The rationale is a tri-axial setup that fits into a 6F radial sheath.  Phenom Plus fits into the 6F Envoy.  A simpler setup without intermediate catheter is suitable for operators with experience and more proximal aneurysms though its not our first choice.  The only downside of this setup is that roadmapping is suboptimal as all catheters fit nicely but without much extra space.

Working projections

VR

Post 2.75×10 PED.

Global post

Nice stereo

Radial sheath injection post embo

See other radial cases here