Flow Diverter as a Sole Treatment for Internal Carotid Termination Aneurysms

Objectives: Treatment of internal carotid artery termination region (ICATR) aneurysms including aneurysms of the true ICA terminus, those inclined on the proximal A1 or M1 segments or at the most distal prebifurcation ICA segment, is often challenging for either surgical or endovascular ways. Few reports had discussed flow diversion as a therapeutic option for this group. In this study, we present the efficiency and safety of flow diversion in our cohort as well as in 27 patients reported in the English literature. Methods: This is a retrospective study analyzing extraluminal flow diversion in treating ICATR aneurysms. Patients' demography, procedural technical description, and angiographic and clinical follow-up were recorded. Results: The mean age was 49 years. Seven patients harboring eight aneurysms in the ICATR have been treated with flow diversion. Five aneurysms were inclined on the proximal A1 segment and three aneurysms were located at the most distal prebifurcation segment. There were four female patients included in this study. The mean aneurysm maximum diameter was 5.3 mm. Two cases presented with acute subarachnoid hemorrhage, four presented with headache, and one had family history of subarachnoid hemorrhage. All patients except one underwent angiographic follow-up. Karman–Byrne occlusion scale was used to determine the occlusion rate. For six patients with a documented angiographic follow-up, all of them had a Class IV occlusion score. No permanent or transient neurological or nonneurological complications were encountered in this study. Conclusion: Treating ICATR aneurysms using flow diversion was feasible with promising angiographic occlusion rate. Further studies are needed to analyze long-term clinical and angiographic results.