Treatment of an acutely ruptured complex fusiform middle cerebral artery aneurysm with flow diverting stenting and adjunctive coil embolization.

This technical video demonstrates the treatment of an acutely ruptured, large, complex left fusiform middle cerebral artery (MCA) aneurysm with endovascular flow diversion with adjunctive coiling in a 27-year-old female. Two telescoping flow-diverting stents (Pipeline Flex) were placed, with partial coiling of a saccular portion of the aneurysm. Technical challenges, alternative treatment, intraoperative and postoperative antiplatelet management, vasospasm treatment, and clinical and radiographic follow-up are described. The video can be found here: https://stream.cadmore.media/r10.3171/2022.7.FOCVID2249.