Case presentation A 50 -year-old man came to the emergency department referring acute onset headache. Emergency brain CT scan showed diffuse bilateral subarachnoid hemorrhage in the Silvian scissure and in the peri-mesencephalic cistern.

CT angiography exam was performed, which showed a “blister-like’ aneurysm of the left vertebral artery (V4) (figure 1 A-B), near to the origin of the left PICA.

Due to the aneurysm morphology, a flow-diverter stent (Fred X 5x36 mm, Microvention) was positioned to treat the aneurysm, administering Cangrelor EV.

CT scan performed 1 month after the procedure showed complete resolution of the aneurysm, with patency of the posterior circulation.

CT angiography exam showed a “blister-like’ aneurysm of the left vertebral artery (V4) (figure 1 A-B), near to the origin of the left PICA, confirmed by VR reconstruction (C) and DSA (D).

(E) VR and MIP reconstructions of CT angiography performed 1 week and (F-G) 1 month after the procedure, showing patency of the posterior circulation, with no signs of reperfusion of the cerebral aneurysm at one month.

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Abstract P028/309 Figure 1

Discussion In this case the use of Cangrelor in an acute setting ensured to correctly treat a Patient who required acute flow-diverter stent placement for a ruptured aneurysm with complex morphology, not otherwise treatable.

This drug has a rapid ’onset’ and ’offset’, thanks to its short half-life, which could be useful in complex cases where high bleeding and thrombotic risks coexist.

Disclosure of Interest Nothing to disclose