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Figure 4: Flow diversion embolization of a ruptured Fisher grade 3 blister aneurysm followed by severe vasospasm and delayed cerebral ischemia. 43-year-old male with remote history of hemicraniectomy for TBI with baseline wheelchair-dependence presented as a Hunt and Hess 1, Fisher 3 subarachnoid hemorrhage (a). Diagnostic cerebral angiography revealed a fusiform blister aneurysm of the left M1 segment (b). He was loaded on aspirin and clopidogrel and underwent placement of a Pipeline® embolization device across the aneurysm from the left M1 segment to the supraclinoid internal carotid artery (c). He developed worsening hydrocephalus on postoperative day 1 and underwent uncomplicated placement of a lumbar drain. On hospital day 4, the patient developed vasospasm (d) and underwent five intra-arterial verapamil injection procedures. He progressed to develop bilateral ACA territory infarctions, and the family decided to withdraw care considering his diminished baseline functional capacity (modified Rankin Scale 6)

Figure 4: Flow diversion embolization of a ruptured Fisher grade 3 blister aneurysm followed by severe vasospasm and delayed cerebral ischemia. 43-year-old male with remote history of hemicraniectomy for TBI with baseline wheelchair-dependence presented as a Hunt and Hess 1, Fisher 3 subarachnoid hemorrhage (a). Diagnostic cerebral angiography revealed a fusiform blister aneurysm of the left M1 segment (b). He was loaded on aspirin and clopidogrel and underwent placement of a Pipeline® embolization device across the aneurysm from the left M1 segment to the supraclinoid internal carotid artery (c). He developed worsening hydrocephalus on postoperative day 1 and underwent uncomplicated placement of a lumbar drain. On hospital day 4, the patient developed vasospasm (d) and underwent five intra-arterial verapamil injection procedures. He progressed to develop bilateral ACA territory infarctions, and the family decided to withdraw care considering his diminished baseline functional capacity (modified Rankin Scale 6)