Competitive flow diversion of multiple P1 aneurysms: proposed classification.
We report the case of a patient with subarachnoid hemorrhage and three aneurysms arising from the posterior communicating artery (Pcomm)-P1 complex, treated with endovascular coiling and competitive flow diversion. The largest and likely ruptured Pcomm aneurysm was treated with traditional coiling. Two smaller potentially ruptured aneurysms arose from the distal right posterior cerebral artery (PCA) P1 segment. After a failed attempt to treat with conventional flow diversion across the PCA-P1 segment, the P1 aneurysms were successfully treated with competitive flow diversion distal to the PCA-P1 segment from Pcomm to the P2 segment. Over 12 months, competitive flow diversion redirected flow to the right PCA territory via the internal carotid artery-Pcomm-P2, reducing the size of the PCA-P1 segment and obliterating the P1 aneurysms. Competitive flow diversion treatment should be considered for aneurysms occurring at the circle of Willis when traditional methods are not feasible. Herein, we introduce a novel classification for competitive flow diversion treatment.
['MacLean|Mark Alexander|MA|http://orcid.org/0000-0002-8535-0776', 'Huynh|Thien J|TJ|', 'Schmidt|Matthias Helge|MH|http://orcid.org/0000-0001-5356-780X', 'Pereira|Vitor M|VM|', 'Weeks|Adrienne|A|']
D017542:Aneurysm, Ruptured D002533:Cerebral Angiography D002560:Cerebrovascular Circulation D002941:Circle of Willis D000072226:Computed Tomography Angiography D057510:Endovascular Procedures D005260:Female D006801:Humans D002532:Intracranial Aneurysm D008875:Middle Aged D020769:Posterior Cerebral Artery D015607:Stents D013345:Subarachnoid Hemorrhage D035703:Therapies, Investigational D016896:Treatment Outcome
aneurysm subarachnoid blood flow flow diverter technique