A 28-year-old man presenting with right third nerve palsy was diagnosed with a giant unruptured aneurysm supplied by the right posterior communicating and cerebral arteries (figure 1, A and B). The aneurysm was treated with flow-diverting stent-assisted coiling. Two months later, he presented with new-onset left-sided weakness, and MRI showed increased edema in the thalamus (figure 1C) and increased aneurysm size and no filling. There was no evidence of stent malapposition with high-resolution cone-beam (VASO) CT (figure 2). Angiography and optical coherence tomography (OCT) imaging demonstrated no stent endothelialization over a patent portion of the aneurysm neck (figure 3).^1,2 A second stent was deployed under OCT guidance for complete aneurysmal embolization. In follow-up at 4 months, the patient was ambulating independently, and repeated MRI showed decrease in the amount of perilesional edema. In summary, OCT allowed for visualization of stent malapposition and small neck remnant, facilitating image-guided stent placement and subsequent embolization of the aneurysmal remnant followed by clinical improvement.