C52 Backyard treatment strategy for aneurysm after recanalization with flowdiverter

<h3>Introduction</h3> Saccular aneurysms are the most prevalent type of aneurysm and can be associated with a dysplastic arterial segment. This cases represents a challenging treatment (for surgical or endovascular technique) but being more advantageous for endovascular approach. We present a case of a terminal carotid dysplastic aneurysm treated with flowdiverter and coils, with posterior recanalization, and being able to completely secure the aneurysm by backyard technique (contralateral approach). <h3>Case Description</h3> We present a 43 year old male, presented with Glasgow scale of 4 and bilateral unreactive pupils. His initial CT head showed Subarachnoid Haemorrhage – Fisher Scale of Grade 4. 3D reconstruction and selective angiogram, showed a sacular aneurysm of anterior segment of carotid T and an associated dysplasic artery. We treated the aneurysm with coils and flowdiverter, due to its vascular features, successfully ( Raymond Roy 1). During his first control at 6 months – Digital substraction angiography showed recanalization of aneurysm, mainly against contralateral carotid inyection across AcomA and A1 left segment ( Raymond Roy Grade 3b). We decided to treat via contralateral access (Right carotid), crossing anterior communicating artery until the sac of aneurysm and dysplastic junction (where anterior choroidal arteries arise), we decided to put coils into sac and occluding left A1 segment to avoid recanalization and keeping anterior choroidal artery patent. Control angiogram after 6 months showed occluded aneurysm. <h3>Conclusions</h3> Endovascular treatment secures a good approach for aneurysm associated with dysplastic arterial segment, and ‘backyard’ technique represents an alternative option for recanalized aneurysm specifically in cases of flowdiverter placement. <h3>Conflict of Interest</h3> No