Achieving adequate wall apposition is a crucial technical goal when deploying flow diverters to treat wide-neck cerebral aneurysms. The socalled J-wiring technique is a common method used to optimize flow diverter wall apposition. However, the frictional interaction between the shaping device and the microguidewire tip during the formation of the J-loop, as well as the interaction between the J-loop and the flow diverter during J-wiring, may potentially cause damage to the guidewire’s coating. Three frequently used guidewires were tested in vitro in a silicone aneurysm model. Manual J-shaping of guidewire tips, along with the J-wiring technique (including J-shaping), caused damage to the surface coating of guidewires, as observed by scanning electron microscopy. Therefore, both mechanisms may contribute to the generation of polymer micro-fragments in patients treated with flow diversion.

Extracranial vascular pathology uncommonly causes intracranial subarachnoid hemorrhage (SAH). Among possible lesions are aneurysms at the craniocervical junction arising from a posterior inferior cerebellar artery (PICA) with an extradural origin. We describe a case of a 55-year-old female presenting with a sudden and severe headache. A computed tomography scan revealed a SAH within the fourth ventricle and cervical spinal canal, and a ruptured saccular aneurysm on a PICA with extradural C2-origin. Despite difficult access anatomy, endovascular treatment was feasible and resulted in subtotal initial occlusion and preservation of distal PICA flow. Upon 3-month follow-up, the aneurysm was completely occluded with a patent PICA. The patient’s clinical status remained stable at the 1.5-year follow-up. In conclusion, we present a rare case of an aneurysm originating from a PICA with extradural C2-origin that was treated endovascularly with preservation of the PICA.

Vertebro-vertebral fistulas (VVFs) are vascular lesions that may develop after trauma or spontaneously in association with connective tissue disorders. We present a rare case of a post-traumatic VVF in a young patient presenting with a painless swelling and a bruit in her left upper neck. Digital subtraction angiography showed an arteriovenous fistula between the left vertebral artery (VA) and the vertebral venous plexus with significant steal phenomenon. Endovascular therapy was performed using a Woven EndoBridgeTM (WEB)-device combined with coils that allowed preservation of the VA. The patient fully recovered from her symptoms and follow-up imaging showed stable occlusion. In conclusion, VVFs can be effectively treated using intrasaccular flow diverters such as the WEB-device, allowing for complete and stable occlusion while preserving the parent artery.