Abstract Number ‐ 85: Distal Anterior Choroidal Artery Fusiform Aneurysm Successfully Treated with Flow Diversion

Abstract

Introduction Anterior choroidal artery (AChA) aneurysms account for 3–5% of intracranial aneurysms, and are often saccular, arising at or near the origin of the AChA, with distal lesions being exceedingly rare. Contrary to saccular aneurysms, fusiform aneurysms are associated with a higher risk of rebleeding and mortality due to their formidable anatomy requiring advanced techniques including bypass, stent‐assisted coiling, and, more recently, flow diversion. While flow diverters are becoming more popular, they are currently only approved forinternal carotid artery segment aneurysms. However, many institutions areexpanding their use to more distal and smaller caliber vessels. Herein we present a novel pathology of a dissecting distal AChA fusiform pseudoaneurysm with a small vessel caliber treated successfully with flow diversion. Methods Case presentation and surgical technique. Results We describe a 40‐year‐old woman with monoclonal gammopathy of unknown significance (MGUS), lichen sclerosis, and an unspecified connective tissue disease presenting with diffuse subarachnoid hemorrhage (SAH) (World Federation of Neurosurgical Societies 1; Hunt & Hess scale 2; Modified Fisher Scale 3). A digital subtraction cerebral angiogram revealed a dissecting (5×3 mm) left AChA pseudoaneurysm, 4mm distal to the origin (Figure 1). Flow Redirection Endoluminal Device (FRED Jr, Microvention, CA) (2.5mm 8/13 working/total length) was deployed within the vessel proximal to the aneurysm, preceded by an infusion of 5mg of verapamil to facilitate stent placement (Figure 2). Post procedure, she remained neurologically intact and was discharged on dual antiplatelet therapy (aspirin/ticagrelor). Repeat cerebral angiogram at six months showed patent flow diversion device and no pseudoaneurysm remnant (Figure 3) with a nonfocal physical examination. Conclusions Flow diversion may be a successful, and safe, therapeutic intervention for challenging distal intracranial aneurysms with smaller caliber vessels.