Figure 2.

Indirect flow diversion for treatment of an incidental broad-based aneurysm of the right-hand side middle cerebral artery in a 53-year-old patient. The aneurysm (5.6 × 3.4 mm fundus, 4-mm neck) arises from the superior trunk of the middle cerebral artery involving the bifurcation of the latter. The closest distance between aneurysm and outer wall of the treated vessel is 1 mm; however, the aneurysm-parent artery interface is significantly distal to the flow diverter. (A) Reconstruction of a 3D rotational angiogram demonstrating the spatial relationship of the aneurysm to the branches of the middle cerebral artery. The aneurysm involves the bifurcation but primarily arises from the superior trunk. The blue arrow indicates the intended proximal and distal landing zones; the goal is to jail the superior trunk and its aneurysm. (B) After implantation of the p48MW-HPC flow-diverter stent, jailing the superior trunk and the temporal branch, the control injection revealed prolonged stasis of the contrast agent within the aneurysm (O‘Kelly-Marotta Grade A2). The white lines indicate the proximal and distal endings of the implanted device. (C) Four months later, the aneurysm is occluded; all branches of the middle cerebral artery, including the superior trunk, remained patent. The white lines indicate the proximal and distal endings of the implanted device.