Introduction Wide neck aneurysms represent a challenge for endovascular treatment. Intrasacular devices don’t offer a solution for very large or giant aneurysms due to lack of large sizes of these device. Here we represent the first case in the US using the largest intrasaccular device used successfully to treat a large basilar tip aneurysm.

Case Description 72 YO woman who is a Chronic smoker with PMH of Moderate cognitive impairment, CAD, Afib, Carotid disease, CKD, MVR and AVR and Recent severe GI bleed and intolerance of blood thinners. CTA with large basilar tip aneurysm. Partially calcified 13.5 X 12 X 16. The base of the aneurysm incorporated the SCAs. Y stenting was avoided due inability to tolerated blood thinners. Balloon assisted coiling was felt to be less effective in protecting the SCAs as well. The patient had severely diseased and tortous bilateral vertebral artery.

An Arc Seal device 15 X 12 mm ( largest device used to date) was used to perform the embolization. The access was via the right vertebral artery via a 6 Fr Sofia, with a Tenzing 7. Despite the severe tortousity the large Seal Arc was very soft and was navigated easily and deployed effectively in the cavity of the aneurysm achieving immediate stasis.Seal

Results Seal device is a promising new device that provide new shapes and sizes in low profile and soft structure that can expand the treatment indications of large wide neck aneurysms. A clinical trial is to-be-initiated in the USA.