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The patient presented with a widely implanted Acom aneurysm on both the Acom artery and the A2 origins. In recent years, there has been a growing interest in employing flow-diversion techniques for treating anterior circulation aneurysms (1-4).
In this case, the aneurysm was primarily opacified from the left circulation, prompting the decision to conduct a flow diversion treatment from the left A2 to the left A1 using a PipelineTM Vantage stent. The distal wall apposition was optimized with a non-flow diverter braided stent. The 3-month follow-up revealed stable aneurysm size and a redirection of the aneurysm flow to the right circulation.
During a subsequent session, a second PipelineTM Vantage stent was successfully implanted from the left A2 to the left A1 without any incidents. The 6-month follow-up demonstrated a significant reduction in saccular flow and aneurysm size.
The technical advancements in the latest generation of flow-diverter stents have supported the expansion of flow-diversion indications. Smaller delivery catheters, such as the Phenom 21 for PipelineTM stents with a diameter of ≤3.5mm, and surface modifications like Shield technology, may facilitate these new strategies while also enhancing safety. These potential benefits warrant further investigation through prospective studies to validate their efficacy and safety improvements.
References
1. Pagiola, I. et al. Flow diversion treatment of aneurysms of the complex region of the anterior communicating artery: which stent placement strategy should ‘I’ use? A single center experience. J Neurointerv Surg 11, 1118 (2019)
2. Clarençon, F. et al. Flow Diverter Stents for the Treatment of Anterior Cerebral Artery Aneurysms: Safety and Effectiveness. Clin. Neuroradiol. 27, 51–56 (2017)
3. Piano, M. et al. Flow Diverter Devices in the Treatment of Anterior Communicating Artery Region Aneurysms: Would the Regional Anatomy and the Aneurysm Location Affect the Outcomes? Brain Sci. 12, 1524 (2022)
4. Dakay, K. et al. Flow diversion in anterior cerebral artery aneurysms. Brain Circ. 7, 247–252 (2021)
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