Quick example — H-Pipe of ACOMs (or H-Flow Diversion lets say) is, in the author’s opinion, the optimal endovascular treament for ACOMs — its the most versatile, most efficacious, and least risky. Same goes for ruptured plug and pipes. A small A1 is way better than none — it will grow and grow. Here is an example of a small one, allowing for more confidence in treatment with undercoiling and one PED
![](https://www.neuroangio.org/wp-content/uploads/Archives/Aneurysm/ACOM-PED-Small-A1/ACOM-pipe-small-A1-01.png)