Archives ACOM aneurysm treatment with bilateral Pipeline devices

Example of another way to attack an ACOM — feasible when both A1 and A2 branches at least ~1.5 mm in diameter.  Bilateral A1 to A2 flow diverter implantation can be technically challenging but ultimately effective

 

ACOM PED A1-A2

Measurements

Access is 027 Phenom and Phenom Plus in the A1.  If i  were to do it again i would use the Navien 058

Run through the Phenom 027 after PED deployment, 2.5×12.

Post deployment there is no longer preferential supply of the right side via the left A1

3D from the right, showing left-sided PED in place.  Notice extra bums on the aneurysm

Accessing the left A2 proved to be the hardest task due to the tortuosity of the vessels.  Finally, an Avigo went through distally enough to allow the Phenom to come off the aneurysm where its edge was being caught.

After placement of the Phenom, confirming patency of vessels and other lack of injury.  I would recommend doing this after complicated maneuvers.  If there is a problem you have a choice to stop.

Post PED, 2.5×14.  Now there is statis in the aneurysm

Post right ICA

Final post from the left, to make sure it is still open