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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
  1. Igor Pagiola1,2,
  2. Cristian Mihalea1,3,
  3. Jildaz Caroff1,
  4. Léon Ikka1,
  5. Vanessa Chalumeau1,
  6. Thomas Yasuda1,
  7. Joaquin Marenco de la Torre1,
  8. Marta Iacobucci1,
  9. Augustin Ozanne1,
  10. Sophie Gallas1,
  11. Marcio Chaves Marques2,
  12. Henrique Carrete4,
  13. Michel Eli Frudit2,
  14. Jacques Moret1,
  15. Laurent Spelle1
  1. 1 NEURI, Hopital Bicetre, Le Kremlin-Bicetre, France
  2. 2 Neurorradiologia Intervencionista, Universidade Federal de Sao Paulo Escola Paulista de Medicina, Sao Paulo, Brazil
  3. 3 Neurosurgery, Universitatea de Medicina si Farmacie Victor Babes din Timisoara, Timisoara, Romania
  4. 4 DDI, Universidade Federal de Sao Paulo Escola Paulista de Medicina, Sao Paulo, Brazil
  1. Correspondence to Dr Igor Pagiola, NEURI, Hopital BicetreLe Kremlin-Bicetre, Île-de-France, France; igorpagiola{at}


Background Aneurysms of the anterior communicating artery (ACoA) are difficult to treat with coiling or clipping because of the anatomical variation in this region. Flow diversion represents a feasible treatment, but no consensus exists as to which stent deployment technique is more suitable.

Methods All patients with ACoA aneurysms treated with flow diverters between April 2014 and November 2018 were retrospectively analyzed. Aneurysm characteristics, follow-up results, and clinical outcome data were recorded, and a new classification comparing the diameters of both A1 segments is proposed: H1=same diameters; H2=<50% difference in diameters; H3= ≥50% difference; and Y=no A1 segment.

Results We analyzed 30 procedures in 30 patients with ACoA aneurysms, including 16 ruptured aneurysms treated with coiling embolization and 4 previously unruptured aneurysms (two Medina and two Woven EndoBridge devices). Adequate aneurysm occlusion occurred in 86.9%; one patient (3.3%) experienced symptomatic ischemic stroke. The global thromboembolic complications for each group were 17.6% (H1), 25% (H2), and 60% (H3).

Conclusion Flow diversion treatment in this region is safe, feasible, and effective. The most suitable anatomical configuration for flow diverter treatment seems to be the H1 configuration where the ‘I technique’ is suitable (from an A1 segment to the ipsilateral A2). There is a tendency that the H3 configuration is not a good indication for flow diverter treatment. However, further studies are needed to evaluate the feasibility of this anatomical classification and the reproducibility of our findings.

  • unruptured aneurysm
  • risk of rupture
  • intracranial aneurysms
  • subarachnoid hemorrhage
  • flow diverter

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  • Contributors Substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of the data for the work was done by the following: IP, CM, JC, LI, MCM, HC, and VC. Drafting the work or revising it critically for important intellectual content was finalized by TY, JMD, MI, AO, and SG. Final approval of the version to be published was done by HC, MEF, JM, and LS. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: CM, JC, and IP. All authors contributed equally to this work.

  • Funding No grant support was obtained for this retrospective study.

  • Competing interests None declared.

  • Ethics approval Our institutional review board approved this retrospective study.

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

  • Patient consent for publication Not required.