{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T07:28:58Z","timestamp":1786692538204,"version":"build-2736575974"},"reference-count":18,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n Flow diverter stents are widely used for internal carotid\u2013posterior communicating artery (IC-PC) aneurysms, and covered branches such as the posterior communicating artery (PcomA) generally remain patent. Branches arising directly from the aneurysm dome, however, occupy a distinct anatomical position and may behave differently.<\/jats:p>\n <\/jats:sec>\n \n Case Description:<\/jats:title>\n A woman in her 50s underwent Pipeline Flex with Shield Technology placement (5.0 \u00d7 16 mm) for a 9.2-mm wide-necked right IC-PC aneurysm. A thin branch arising directly from the aneurysm dome was preoperatively interpreted as a hypoplastic PcomA, with anticipated collateral support from an adequate ipsilateral P1 segment. Preoperative platelet function testing revealed clopidogrel non-response (adenosine diphosphate inhibition, 7.6%). On postoperative day 4, the patient developed left hemiparesis. Diffusion-weighted imaging demonstrated acute infarction in the right anterolateral thalamus, while digital subtraction angiography confirmed complete aneurysm thrombosis with disappearance of the branch and a fully patent stent. Vertebral artery angiography showed no retrograde filling of the PcomA. The hemiparesis resolved rapidly, but visuospatial and attentional-executive deficits persisted; the modified Rankin Scale score remained 2 at 18 months.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n When a hypoplastic PcomA arising from the aneurysm dome functions as a dominant terminal feeder of the anterior thalamoperforating artery, progressive intra-aneurysmal thrombosis after flow diversion may cause thalamic infarction\u2014a risk incompletely addressed by antiplatelet optimization alone. An adequate P1 segment does not guarantee perfusion of such a dome-originating perforator. Preoperative functional assessment of collateral supply and branch-preserving alternatives merit consideration in this configuration.<\/jats:p>\n <\/jats:sec>","DOI":"10.25259\/sni_831_2026","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T06:53:29Z","timestamp":1786690409000},"page":"462","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ischemic complication in the anterior thalamoperforating artery territory following flow diverter stent placement for an internal carotid\u2013posterior communicating artery 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