Introduction Ruptured AVM with intra-nidal aneurysm still carry significant risk of treatment especially in the brain stem originating from basilar artery perforators
Aim of Study To report a case of using liquid embolic and micro-coils in the setting of intra-nidal embolization of a pontine perforator.
Methods We present a case of a 75-year-old female who was found to have SAH and incidental aneurysm. The patient was found to have an incidental aneurysm that was treated and AVM that was missed. Upon re-rupture the patient presented to the hospital and she was found to have coil compaction of the previously treated aneurysm and the AVM was discovered and was found to have intra-nidal AVM.
Results Repeated diagnostic cerebral angiogram revealed a small brain stem AVM with intra-nidal aneurysm that was felt to be the culprit lesion of the bleeding. This was found few weeks after the rupture. The intra-nidal aneurysm was treated by means of small Barcade coils through Marathon catheter in the aneurysm through the pontine perforator. This was followed by embolization through the marathon catheter of liquid embolic n-BCA. The aneurysm disappeared completely post embolization and the residual AVM was then treated by means of radiosurgery successfully
Conclusion Using small profile coils and n-BCA is useful in certain complex AVM.
Disclosure of Interest None
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