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Original research
Flow diversion for anterior choroidal artery (AChA) aneurysms: a multi-institutional experience
  1. Visish M Srinivasan1,
  2. Michael George Zaki Ghali1,
  3. Jacob Cherian1,
  4. Maxim Mokin2,
  5. Ajit S Puri3,
  6. Ramesh Grandhi4,
  7. Stephen R Chen5,
  8. Jeremiah N Johnson1,
  9. Peter Kan1
  1. 1 Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
  2. 2 Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
  3. 3 Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  4. 4 Department of Neurosurgery, University of Texas, San Antonio, Texas, USA
  5. 5 Department of Radiology, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr Peter Kan, Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA; peter.kan{at}


Background Anterior choroidal artery (AChA) aneurysms represent a small subset of cerebral aneurysms. The Pipeline Embolization Device (PED) has been successfully applied to various aneurysms of the supraclinoid internal carotid artery (ICA). The treatment of these aneurysms requires special attention due to the eloquent territory supplied by the AChA. We report the largest and first dedicated series of flow diversion treatment of AChA aneurysms.

Methods Four institutional neurointerventional databases were reviewed for cases of intracranial aneurysms treated with PED. Patient and aneurysm data as well as angiographic imaging were reviewed for all cases of AChA aneurysms treated with PED. AChA aneurysms were defined as aneurysms distal to the AChA and proximal to the ICA terminus, with or without the incorporation of the AChA.

Results Eighteen AChA aneurysms were treated during the study period. All aneurysms were successfully treated with a mean follow-up of 19.1 months. The large majority of aneurysms (15/18, 83.3%) were completely obliterated. No patients suffered from intra- or post-procedural complications. A1 stenosis was a common occurrence, seen in 10 of 16 (62.5%) covered anterior cerebral arteries (ACAs), although all were asymptomatic. All AChAs remained patent at last follow-up.

Conclusions The PED can be used successfully in AChA aneurysms with a good safety and efficacy profile. All AChAs remained patent. Collateral flow networks, especially for the ACA, affect long-term branch vessel patency. Treatment with PED for AChA aneurysms appears to be a reasonable option to consider and should be evaluated in a larger cohort.

  • artery
  • hemorrhage
  • aneurysm
  • angiography
  • flow diverter

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  • Contributors All authors met the criteria for authorship.

  • Competing interests None declared.

  • Ethics approval Institutional Review Boards at each of the involved institutions.

  • Provenance and peer review Not commissioned; externally peer reviewed.