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
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