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Safety and Efficacy of Flow Diverters for Treatment of Unruptured Anterior Communicating Artery Aneurysms: Retrospective Multicenter Study
  1. Victor H C Benalia1,
  2. Gustavo M Cortez1,
  3. Charbel Mounayer2,
  4. Isil Saatci3,
  5. H Saruhan Cekirge3,
  6. Naci Kocer4,
  7. Civan Islak4,
  8. Guilherme Dabus5,
  9. Waleed Brinjikji6,
  10. Feyyaz Baltacioglu7,
  11. Vitor M Pereira8,
  12. Hidehisa Nishi8,
  13. Adnan H Siddiqui9,
  14. Andre Monteiro9,
  15. Demetrius K Lopes10,
  16. Amin Aghaebrahim1,
  17. Eric Sauvageau1,
  18. Ricardo A Hanel1
  1. 1 Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
  2. 2 Interventional Neuroradiology Department, University Hospital Centre of Limoges, Limoges, France
  3. 3 Interventional Neuroradiology Department, Koru Health Group, Ankara, Turkey
  4. 4 Department of Radiology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Fatih, Istanbul, Turkey
  5. 5 Interventional Neuroradiology and Neuroendovascular Surgery, Miami Neuroscience Institute and Miami Cardiac and Vascular Institute-Baptist Hospital, Miami, Florida, USA
  6. 6 Department of Neurosurgery and Neuroradiology, Mayo Clinic, Rochester, Minnesota, USA
  7. 7 Department of Radiology, Division of Interventional Radiology/Neuroradiology, VKV Amerikan Hastanesi, Istanbul, Turkey
  8. 8 Department of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada
  9. 9 Departments of Neurosurgery and Radiology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
  10. 10 Neurosurgery, Brain and Spine Institute-Advocate Aurora Health, Chicago, Illinois, USA
  1. Correspondence to Dr Ricardo A Hanel, Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, FL 32207, USA; ricardo.hanel{at}


Background The anterior communicating artery (AComm) region is the most common site of intracranial aneurysms, with increased rupture risk compared with other locations. Overall, flow diverters present as a safe and efficacious treatment for intracranial aneurysms, but there is paucity of data for their use in the treatment of unruptured AComm aneurysms. We present the largest multicentric analysis evaluating the outcomes of flow diverters in AComm aneurysm treatment.

Methods Databases from 10 centers were retrospectively reviewed for unruptured AComm aneurysms treated with flow diverters. Demographics, clinical presentation, radiographic characteristics, procedural complications, and outcomes were assessed.

Results A total of 144 patients harboring 147 AComm aneurysms were treated between January 2012 and December 2021. Seventy-four were women (51.4%) and median age was 60 (IQR 50–67) years. All were unruptured AComm aneurysms. Half of the cohort had similar anterior cerebral artery sizes (51.4%). The most common morphology was saccular (94.6%), with a branch involvement in 32.7% of cases. Median vessel diameter was 2.4 mm, and the Pipeline Flex was the most prevalent device (32.7%). Median follow-up time was 17 months, with complete occlusion in 86.4% at the last follow-up. Functional independence (modified Rankin Scale score 0–2) was reported in 95.1%. Intraprocedural complications occurred in 5.6%, and postoperative complications were noted in 9.7% of cases. Combined major complication and mortality rate was 2.1%.

Conclusions Our study suggests that flow diverters are a useful treatment for AComm aneurysms. Mid-term results indicated favorable aneurysm occlusion with a good safety profile. Additional prospective studies with longer follow-up periods and independent adjudication are warranted to better assess these results.

  • flow diverter
  • aneurysm
  • intervention
  • subarachnoid
  • device

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Twitter @victorhbenalia, @VitorMendesPer1, @drnimajax

  • Contributors RAH, VHCB, and GMC are the guarantor authors of the manuscript. RAH, VHCB, and GMC drafted the initial manuscript. All authors were involved and made substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of the data; revising it critically for important intellectual content; final approval of the version published; and 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.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests IS is a consultant for Medtronic and Microvention. HSC is a stockholder from Neuravention, Vesalio, Syncron Tech, Bend It Tech, and Sim&Size, and is a consultant for Medtronic and Microvention. NK is a consultant and proctoring for Microvention. CI is a speaker for Microvention, holds patent from 4D G1 coil, and is a stockholder of Neuravention and Bend It. GD has consulting agreements with Microvention, Medtronic, Cerenovus, Stryker, Penumbra, and InNeuroCo. RAH is a consultant for Medtronic, Stryker, Cerenovous, Microvention, Balt, Phenox, Rapid Medical, and Q'Apel, is on the advisory board for MiVI, eLum, Three Rivers, Shape Medical, and Corindus, has unrestricted research grants from NIH, Interline Endowment, Microvention, Stryker, and CNX, and is an investor/stockholder for InNeuroCo, Cerebrotech, eLum, Endostream, Three Rivers Medical, Scientia, RisT, BlinkTBI, and Corindus. VMP serves as a consultant/steering committee member for Stryker, Penumbra, and Balt, a consultant for Medtronic and Neurovasc, and receives a research grant from Philips. DKL reports conflicts of interest with Medtronic and Stryker, being the national PI of the ADVANCE trial, receiving research grants, and being part of their advisory board.

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

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