Introduction: Endovascular embolization has become a mainstay and preferred treatment modality for ruptured intracranial aneurysms. Wide necked aneurysms remain challenging for endovascular treatment due to challenges in obtaining adequate packing, recurrence, and coil herniation. Stent assistance for parent vessel protection has been considered; however, it is recommended dual antiplatelets be used for thrombotic prophylaxis due to increased metal content within the lumen of the vessel. The pulse rider by Cerenovus is a device with reduced intralumenal metal content with increased neck coverage for wide neck bifurcation aneurysms. Here we present one such case.

Case report: A 52 yo F with a history of Moya Moya, metastatic melanoma, and a basilar aneurysm with a 6 mm neck and 7 mm dome presented with an acute nontruamatic subarachnoid hemorrhage with dilated ventricles compared to baseline. Following placement of an external ventricular drain, a cone beam CT was obtained to ensure no new hemorrhage and good position of the drain. Following obtaining vascular access, a 325 mg ASA was administered via nasogastric tube. A benchmark catheter was placed in the left vertebral artery and angiography performed. A prowler select plus was used to position a 2.7-3.5 mm 8T pulse rider. Subsequent, platinum coil embolization ensued achieving Roy Raymond II occlusion. The patient was recovered from anesthesia and returned to the ICU where she was started on a daily clopidogrel of 75 mg. The ventricular drain was removed on hospital day 8. No hemorrhagic complications occurred and the patient was discharged to rehab.

PULSE RIDER ASSISTED COILING OF ACUTELY RUPTURED WIDE NECKED BASILAR APEX ANEURYSM