Competitive flow diversion of multiple P1 aneurysms: proposed classification

Area of Science:

• Neurosurgery
• Endovascular Therapy
• Cerebrovascular Disease

Background:

• Subarachnoid hemorrhage presents a significant risk, often associated with complex intracranial aneurysms.
• Traditional endovascular coiling and flow diversion have limitations for certain aneurysm morphologies.

Observation:

• A patient with subarachnoid hemorrhage and multiple posterior communicating artery aneurysms was treated.
• Initial coiling addressed the largest aneurysm, but smaller posterior cerebral artery (PCA) P1 segment aneurysms required alternative strategies.

Findings:

• Conventional flow diversion across the PCA-P1 segment was unsuccessful.
• Competitive flow diversion, from Pcomm to P2, successfully treated the PCA-P1 aneurysms.
• Over 12 months, this technique reduced PCA-P1 segment size and obliterated the aneurysms by redirecting flow.

Implications:

• Competitive flow diversion offers a viable alternative for complex intracranial aneurysms at the circle of Willis.
• This case introduces a novel classification for competitive flow diversion, advancing treatment strategies.
• Endovascular treatment of complex cerebrovascular aneurysms may benefit from this innovative approach.