Introduction Wide-neck bifurcation aneurysms remain challenging for endovascular treatment and often demand complex combinations of implants. TRENZA is a new internal remodeling implant to be combined with conventional coils. Here, we present 3 cases of unusual utilisation of TRENZA.

Case Description 3 female patients are presented.

Pat. #1: 78 year-old with ASA allergy and an incidental PCOM sidewall aneurysm, which could be adequately occluded with TRENZA and coils. No stent or flow diverter was needed. 6-Mon F/U shows stable small remnant.

Pat. #2: 91 year old with SAH from complex large (> 10 mm) MCA bifurcation aneurysm, other suitable intrasaccular devices were not available. Pragmatic treatment with TRENZA and coils. Patient survived and has been discharged to permanent care facility.

Pat. #3: 59 year old with SAH from dissecting V4 aneurysm with close relationship to PICA and anterior spinal artery. Targeted parent vessel occlusion could be done with TRENZA and coils without complications. Patient has improved clinically and was discharged to rehabilitation unit.

Results The TRENZA device offers stable framing not only for saccular aneurysms but also in situations beyond. It is a promising addition to the neurointerventional armamentarium.