A 76-year-old woman was admitted to our neurosurgical department with a 2-month history of confusion, gait imbalance, and urinary incontinence. The patient underwent a brain magnetic resonance imaging (MRI) investigation, which revealed the presence of a giant BAA associated with brainstem compression and obstructive hydrocephalus (Fig. 1a, b). Digital subtraction angiography (DSA) also showed the origin of both the PCAs and SCAs from the sac at the neck of the aneurysm (Fig. 1c, d).

After we engaged in a thorough multidisciplinary discussion, surgical clipping reconstruction was excluded because of the patient’s advanced age and comorbidities; traditional coiling was also not appropriate because it could not guarantee preservation of the blood flow in the parent arteries.

Therefore, we decided to use a pCONus ® stent (Phenox) with its upper extremities (petals) anchored over the ostia of the parent vessels (Fig. 2a–d). The provided bridging structure allowed the dislocation of 52 coils (Target, Axium, and Versatile Range Fill Advanced Coils (Microvention), ®) to completely fill out the dome of the sac, which was excluded by the circulation (Fig. 2b, c and e), and at the same time, we obtained a reconstruction of the neck of the aneurysm, which preserved the blood flow in the parent vessels (Fig. 2f). The procedure was performed by the senior author (Alessandro Pedicelli).