Recurrent Wide-Necked Bifurcation Aneurysm: Treatment Using PulseRider® as an Adjunctive Device

A 53-year-old female had an anterior communicating artery (ACOM) aneurysm (Fig. 35.1a) treated electively with balloon-assisted coiling (Fig. 35.1b, c). Six months later, a repeat catheter angiogram showed significant recurrence of the aneurysm (Fig. 35.1d). Treatment options were assessed and the pros and cons discussed in a neurovascular multidisciplinary team meeting. The patient was offered either surgery or endovascular treatment and she opted for the former. However, after failed attempt at surgical management, the endovascular options were re-evaluated, and a PulseRider® (Pulsar Vascular, San Jose, CA, USA) assisted coiling was considered (Figs. 35.2 and 35.3).