Precision/personalized aneurysm treatment in era of increasing options

Excerpt

I congratulate the authors in the management of this unusual problem that arose from stent-assisted coiling of a right middle cerebral artery aneurysm. There is no doubt, based on the provided imaging, that the aneurysm cannot be treated with simple coiling and requires an adjunct such as stenting. In the management of their complication, the authors demonstrate the vast tools available in their armamentarium to manage cerebrovascular diseases. Amongst those discussed in the paper in the management of this patient are innovative clip wrapping of the stent perforation and bypass. If one takes a step back and reassesses this aneurysm, we have a right middle cerebral artery aneurysm that with the demonstrated expertise by the author in this paper could probably easily be treated with microsurgical clipping. Instead, we have a novel complication that is managed with an innovative microsurgical strategy while on antiplatelet therapy. Though I congratulate the authors on the management of this complication, I have reservations in the decision making in proceeding with stent-assisted coiling of this aneurysm. …