Introduction/Purpose Certain AComm aneurysm morphologies are not amenable for coiling or stent-assisted coil embolization. For patients in whom the aneurysm needs to be protected, but neurosurgical clipping is not an option, flow diversion may be a good treatment choice. Placement of flow diverters into each ACA will reduce the flow across the AComm artery and into the aneurysm sac. Complete aneurysm occlusion may sometimes not be achieved given the continued albeit reduced blood flow across the AComm artery itself but the reduction of intrasaccular flow could suffice in minimizing the risk of aneurysm rupture and growth.

Materials and Methods Retrospective review of our prospectively maintained neurointerventional database and identification of all patients who underwent bilateral ACA flow diverter placement for treatment of an AComm aneurysm between March 2019 and June 2022. Patient characteristics, procedural information and available patient outcome was collected.

Results We identified 4 patients (2 females) with mean age of 65 years who underwent bilateral ACA flow diverter placement for treatment of AComm artery aneurysms otherwise not amenable for other endovascular treatment or neurosurgical clipping. One patient suffered a ruptured blister aneurysm. Mean unruptured aneurysm size was 3.6 mm. two patients were treated with bilateral ACA Pipeline Flex (Medtronic) flow diverters and two patients with FRED X (Microvention) flow diverters. Foreshortening of one Pipeline device occurred which required placement of a second device. Acute in-device thrombus formation was seen in the patient with the ruptured AComm blister aneurysm which was successfully treated with intra-arterial integrilin administration and no worsening of the patient’s subarachnoid hemorrhage. All patients recovered well from the procedures and were discharged with mRS 0. Dual antiplatelet regimen consisted of ASA and Plavix for all patients. One patient was lost to follow-up. A more recent case is due for first follow-up in a couple of months. Available 6-month follow-up showed near complete occlusion in 1 patient and partial occlusion in another patient. Partial aneurysm occlusion continued to improve but per definition remained less than 90% at 3 years.

Conclusion Placement of bilateral ACA flow diverters for treatment of AComm aneurysms is a good endovascular option in selected patients. Reduction of flow across the AComm artery may suffice to reduce flow into the aneurysm sac and minimize the risk of aneurysm growth and/or rupture.

Disclosures A. Kuhn: None. J. Singh: None. S. Sarid: None. K. de Macedo Rodrigues: None. M. Garcia: None. A. Puri: 1; C; Consultant for Medtronic Neurovascular, Stryker NeurovascularBalt, Q’Apel Medical, Cerenovus, Microvention, Imperative Care, Agile, Merit, CereVasc and Arsenal Medical. 2; C; NIH, Microvention, Cerenovus, Medtronic Neurovascular and Stryker Neurovascular. 4; C; InNeuroCo, Agile, Perfuze, Galaxy and NTI.