Exclusion of the anterior communicating artery with endovascular flow diverters - A possible treatment method of a wide-necked aneurysm

Introduction: We describe a case of a patient with severe subarachnoid hemorrhage from the rupture of difficultto-treat morphology, a suspected partially thrombosed anterior communicating artery aneurysm. Case presentation: The patient was admitted with World Federation of Neurosurgeons (WFNS) score of 4 and a Fisher grade IV hemorrhage. Angiography demonstrated a wide neck anterior communicating artery aneurysm not suitable for the standard coiling and surgical treatment. On the 10th day after the bleeding, endovascular treatment was performed to exclude the anterior communicating artery from the circulation by implanting flow diverters to A2 to A1 on both sides. On Day 18, a CT1 scan showed communicating hydrocephalus, and thus the patient was treated with a ventriculoperitoneal shunt. At the four-month follow-up, angiography showed O'Kelly-Marotta grade D aneurysm occlusion, and the patient's modified Rankin score was 0. The patient made a complete recovery. Discussion: Even though this was a rare application of the flow diverter, other treatment approaches, including detachable coil, stent implantation, and surgical clipping were considered less safe and less effective treatment in this case of anterior communicating artery aneurysm. Conclusion: Endovascular exclusion of the anterior communicating artery from the circulation may be a safe and effective treatment approach in cases without significant perforant artery branches where the conventional endovascular treatment is not considered to be applicable.