I used the 014 Transend wire to probe the neck and define it better. After placing the tip in the aneurysm, I pulled it back until it deflected up to identify the proximal aspect, then advanced it until it deflected down to demonstrate the distal margin. It looked to be at least 7-8 mm long. The actual diameter of the aneurysm was 22 mm.
|Since I don't have Neuroform yet, and since I wasn't convinced he had adequate collateral flow through that small ACOM to allow sacrifice of the RICA, I decided to partially coil using balloon remodeling if necessary in order to protect the aneurysm from re-rupture. I was also hoping that with a few coils, the aneurysm might thrombose off on it's own. High-flow bypass was not a viable option at our institution. My thought was that if he recovered, we could place a Neuroform when feasible and finish the coiling in case it didn't thrombose off on its own.|