{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T04:21:03Z","timestamp":1770351663036,"version":"3.49.0"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"7","license":[{"start":{"date-parts":[[2023,8,14]],"date-time":"2023-08-14T00:00:00Z","timestamp":1691971200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,14]]},"abstract":"\n BACKGROUND<\/jats:title>\n Anterior choroidal artery (AChA) fusiform aneurysms are exceedingly rare and associated with high rebleeding and mortality rates. Their difficult anatomy comes with a broad range of treatment options, including bypass, stent-assisted coiling, and flow diversion. Currently, flow diverters are approved for large-caliber internal carotid artery segment aneurysms. However, many institutions have expanded their use to distal small-caliber vessels, which raises questions regarding device sizing and long-term patency. The authors present a dissecting distal AChA fusiform pseudoaneurysm treated successfully with flow diversion.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 40-year-old woman with monoclonal gammopathy of unknown significance, lichen sclerosis, and an unspecified connective tissue disease presented with diffuse subarachnoid hemorrhage. She had a dissecting, 5 \u00d7 3\u2013mm, left AChA pseudoaneurysm 4 mm distal to the origin of the vessel. A 2.5-mm flow redirection endoluminal device was deployed. There were no procedural complications. A 6-month cerebral angiogram showed device patency and no pseudoaneurysm remnant. These results were maintained at 1 year as seen on head magnetic resonance angiography.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Flow diversion is a successful and safe therapeutic intervention for challenging intracranial aneurysms originating from small-caliber vessels supplying eloquent vascular territories.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case2386","type":"journal-article","created":{"date-parts":[[2023,8,14]],"date-time":"2023-08-14T20:49:05Z","timestamp":1692046145000},"source":"Crossref","is-referenced-by-count":0,"title":["Use of a flow diverter in a small-caliber end artery anterior choroidal dissecting pseudoaneurysm: illustrative case"],"prefix":"10.3171","volume":"6","author":[{"given":"Griffin","family":"Ernst","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noor A.","family":"Mahmoud","sequence":"additional","affiliation":[{"name":"Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Audrey","family":"Grossen","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Bauer","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"AJNR Am J Neuroradiol","first-page":"314","article-title":"Endovascular treatment of anterior choroidal artery aneurysms","volume":"25","author":"Piotin M","year":"2004","unstructured":"Piotin M, Mounayer C, Spelle L, Williams MT, Moret J. Endovascular treatment of anterior choroidal artery aneurysms. AJNR Am J Neuroradiol. 2004;25(2):314\u2013318."},{"issue":"1","key":"b2","series-title":"Acta Neurochir (Wien)","first-page":"53","article-title":"Distal anterior choroidal artery aneurysm following iatrogenic posterior cerebral artery occlusion : a case report and review of literature","volume":"154","author":"Dolati P","year":"2012","unstructured":"Dolati P, Sutherland G, Wong J, Hudon M, Goyal M. Distal anterior choroidal artery aneurysm following iatrogenic posterior cerebral artery occlusion : a case report and review of literature. Acta Neurochir (Wien). 2012;154(1):53\u201357."},{"key":"b3","series-title":"Neurosurgery","first-page":"S85","article-title":"Expanding indications for flow diverters: distal aneurysms, bifurcation aneurysms, small aneurysms, previously coiled aneurysms and clipped aneurysms, and carotid cavernous fistulas","volume":"86","author":"Limbucci N","year":"2020","unstructured":"Limbucci N, Leone G, Renieri L, Expanding indications for flow diverters: distal aneurysms, bifurcation aneurysms, small aneurysms, previously coiled aneurysms and clipped aneurysms, and carotid cavernous fistulas. Neurosurgery. 2020;86(suppl 1):S85\u2013S94."},{"issue":"3","key":"b4","series-title":"AJNR Am J Neuroradiol","first-page":"590","article-title":"flow diversion in ruptured intracranial aneurysms: a meta-analysis","volume":"38","author":"Madaelil TP","year":"2017","unstructured":"Madaelil TP, Moran CJ, Cross DT 3rd, Kansagra AP. flow diversion in ruptured intracranial aneurysms: a meta-analysis. AJNR Am J Neuroradiol. 2017;38(3):590\u2013595."},{"issue":"4","key":"b5","series-title":"Int J Med Sci","first-page":"368","article-title":"Clinical importance of the anterior choroidal artery: a review of the literature","volume":"15","author":"Yu J","year":"2018","unstructured":"Yu J, Xu N, Zhao Y, Yu J. Clinical importance of the anterior choroidal artery: a review of the literature. Int J Med Sci. 2018;15(4):368\u2013375."},{"issue":"3","key":"b6","series-title":"Clin Neuroradiol","first-page":"459","article-title":"Treatment of unruptured, saccular, anterior choroidal artery aneurysms with flow diversion : a single centre experience","volume":"29","author":"Bhogal P","year":"2019","unstructured":"Bhogal P, Ganslandt O, B\u00e4zner H, Henkes H, Aguilar Perez M. Treatment of unruptured, saccular, anterior choroidal artery aneurysms with flow diversion : a single centre experience. Clin Neuroradiol. 2019;29(3):459\u2013465."},{"issue":"3","key":"b7","series-title":"AJNR Am J Neuroradiol","first-page":"537","article-title":"Patency of the anterior choroidal artery after flow-diversion treatment of internal carotid artery aneurysms","volume":"36","author":"Brinjikji W","year":"2015","unstructured":"Brinjikji W, Kallmes DF, Cloft HJ, Lanzino G. Patency of the anterior choroidal artery after flow-diversion treatment of internal carotid artery aneurysms. AJNR Am J Neuroradiol. 2015;36(3):537\u2013541."},{"issue":"7","key":"b8","series-title":"J Neurointerv Surg","first-page":"634","article-title":"Flow diversion for anterior choroidal artery (AChA) aneurysms: a multi-institutional experience","volume":"10","author":"Srinivasan VM","year":"2018","unstructured":"Srinivasan VM, Ghali MGZ, Cherian J, Flow diversion for anterior choroidal artery (AChA) aneurysms: a multi-institutional experience. J Neurointerv Surg. 2018;10(7):634\u2013637."},{"issue":"9","key":"b9","series-title":"J Neurointerv Surg","first-page":"634","article-title":"Flow diverter stents for unruptured saccular anterior circulation perforating artery aneurysms: safety, efficacy, and short-term follow-up","volume":"7","author":"K\u00fchn AL","year":"2015","unstructured":"K\u00fchn AL, Hou SY, Perras M, Flow diverter stents for unruptured saccular anterior circulation perforating artery aneurysms: safety, efficacy, and short-term follow-up. J Neurointerv Surg. 2015;7(9):634\u2013640."},{"issue":"12","key":"b10","series-title":"J Neurointerv Surg","first-page":"e35","article-title":"Intermediate catheter placement distal to the cerebral aneurysm during flow diversion embolization with the Surpass device","volume":"10","author":"Topcuoglu OM","year":"2018","unstructured":"Topcuoglu OM, Arat A, Peker A, Sarikaya B. Intermediate catheter placement distal to the cerebral aneurysm during flow diversion embolization with the Surpass device. J Neurointerv Surg. 2018;10(12):e35."},{"issue":"1","key":"b11","series-title":"J Cerebrovasc Endovasc Neurosurg","first-page":"47","article-title":"Anterior choroidal artery aneurysms: influence of regional microsurgical anatomy on safety of endovascular treatment","volume":"20","author":"Ghali MGZ","year":"2018","unstructured":"Ghali MGZ, Srinivasan VM, Wagner KM, Lam S, Johnson JN, Kan P. Anterior choroidal artery aneurysms: influence of regional microsurgical anatomy on safety of endovascular treatment. J Cerebrovasc Endovasc Neurosurg. 2018;20(1):47\u201352."},{"issue":"4","key":"b12","series-title":"J Neurosurg","first-page":"1064","article-title":"Patency of anterior circulation branch vessels after Pipeline embolization: longer-term results from 82 aneurysm cases","volume":"126","author":"Rangel-Castilla L","year":"2017","unstructured":"Rangel-Castilla L, Munich SA, Jaleel N, Patency of anterior circulation branch vessels after Pipeline embolization: longer-term results from 82 aneurysm cases. J Neurosurg. 2017;126(4):1064\u20131069."},{"issue":"4","key":"b13","series-title":"Asian J Neurosurg","first-page":"327","article-title":"The unusual angiographic course of intracranial pseudoaneurysms","volume":"10","author":"Zanaty M","year":"2015","unstructured":"Zanaty M, Chalouhi N, Jabbour P, Starke RM, Hasan D. The unusual angiographic course of intracranial pseudoaneurysms. Asian J Neurosurg. 2015;10(4):327\u2013330."},{"key":"b14","series-title":"J Clin Neurosci","first-page":"166","article-title":"Experience with FRED junior flow diverter in treatment of cerebral aneurysms at or distal to the circle of Willis","volume":"69","author":"Sivasankar R","year":"2019","unstructured":"Sivasankar R, Shrivastava M, Limaye US. Experience with FRED junior flow diverter in treatment of cerebral aneurysms at or distal to the circle of Willis. J Clin Neurosci. 2019;69:166\u2013169."},{"issue":"6","key":"b15","series-title":"J Neurosurg Sci","first-page":"702","article-title":"Flow diversion for small caliber vessel aneurysms: efficacy, safety, and functional outcome","volume":"63","author":"Sweid A","year":"2019","unstructured":"Sweid A, Starke RM, Herial N, Flow diversion for small caliber vessel aneurysms: efficacy, safety, and functional outcome. J Neurosurg Sci. 2019;63(6):702\u2013713."},{"key":"b16","series-title":"World Neurosurg","first-page":"e193","article-title":"Tiny pipes: 67 cases of flow diversion for aneurysms in distal vessels measuring less than 2.0 mm","volume":"127","author":"Bender MT","year":"2019","unstructured":"Bender MT, Zarrin DA, Campos JK, Tiny pipes: 67 cases of flow diversion for aneurysms in distal vessels measuring less than 2.0 mm. World Neurosurg. 2019;127:e193\u2013e201."},{"issue":"2","key":"b1","series-title":"AJNR Am J Neuroradiol","first-page":"314","article-title":"Endovascular treatment of anterior choroidal artery aneurysms","volume":"25","author":"Piotin M","year":"2004","unstructured":"Piotin M, Mounayer C, Spelle L, Williams MT, Moret J. Endovascular treatment of anterior choroidal artery aneurysms. AJNR Am J Neuroradiol. 2004;25(2):314\u2013318."},{"issue":"1","key":"b2","series-title":"Acta Neurochir (Wien)","first-page":"53","article-title":"Distal anterior choroidal artery aneurysm following iatrogenic posterior cerebral artery occlusion : a case report and review of literature","volume":"154","author":"Dolati P","year":"2012","unstructured":"Dolati P, Sutherland G, Wong J, Hudon M, Goyal M. Distal anterior choroidal artery aneurysm following iatrogenic posterior cerebral artery occlusion : a case report and review of literature. Acta Neurochir (Wien). 2012;154(1):53\u201357."},{"key":"b3","series-title":"Neurosurgery","first-page":"S85","article-title":"Expanding indications for flow diverters: distal aneurysms, bifurcation aneurysms, small aneurysms, previously coiled aneurysms and clipped aneurysms, and carotid cavernous fistulas","volume":"86","author":"Limbucci N","year":"2020","unstructured":"Limbucci N, Leone G, Renieri L, Expanding indications for flow diverters: distal aneurysms, bifurcation aneurysms, small aneurysms, previously coiled aneurysms and clipped aneurysms, and carotid cavernous fistulas. Neurosurgery. 2020;86(suppl 1):S85\u2013S94."},{"issue":"3","key":"b4","series-title":"AJNR Am J Neuroradiol","first-page":"590","article-title":"flow diversion in ruptured intracranial aneurysms: a meta-analysis","volume":"38","author":"Madaelil TP","year":"2017","unstructured":"Madaelil TP, Moran CJ, Cross DT 3rd, Kansagra AP. flow diversion in ruptured intracranial aneurysms: a meta-analysis. AJNR Am J Neuroradiol. 2017;38(3):590\u2013595."},{"issue":"4","key":"b5","series-title":"Int J Med Sci","first-page":"368","article-title":"Clinical importance of the anterior choroidal artery: a review of the literature","volume":"15","author":"Yu J","year":"2018","unstructured":"Yu J, Xu N, Zhao Y, Yu J. Clinical importance of the anterior choroidal artery: a review of the literature. Int J Med Sci. 2018;15(4):368\u2013375."},{"issue":"3","key":"b6","series-title":"Clin Neuroradiol","first-page":"459","article-title":"Treatment of unruptured, saccular, anterior choroidal artery aneurysms with flow diversion : a single centre experience","volume":"29","author":"Bhogal P","year":"2019","unstructured":"Bhogal P, Ganslandt O, B\u00e4zner H, Henkes H, Aguilar Perez M. Treatment of unruptured, saccular, anterior choroidal artery aneurysms with flow diversion : a single centre experience. Clin Neuroradiol. 2019;29(3):459\u2013465."},{"issue":"3","key":"b7","series-title":"AJNR Am J Neuroradiol","first-page":"537","article-title":"Patency of the anterior choroidal artery after flow-diversion treatment of internal carotid artery aneurysms","volume":"36","author":"Brinjikji W","year":"2015","unstructured":"Brinjikji W, Kallmes DF, Cloft HJ, Lanzino G. Patency of the anterior choroidal artery after flow-diversion treatment of internal carotid artery aneurysms. AJNR Am J Neuroradiol. 2015;36(3):537\u2013541."},{"issue":"7","key":"b8","series-title":"J Neurointerv Surg","first-page":"634","article-title":"Flow diversion for anterior choroidal artery (AChA) aneurysms: a multi-institutional experience","volume":"10","author":"Srinivasan VM","year":"2018","unstructured":"Srinivasan VM, Ghali MGZ, Cherian J, Flow diversion for anterior choroidal artery (AChA) aneurysms: a multi-institutional experience. J Neurointerv Surg. 2018;10(7):634\u2013637."},{"issue":"9","key":"b9","series-title":"J Neurointerv Surg","first-page":"634","article-title":"Flow diverter stents for unruptured saccular anterior circulation perforating artery aneurysms: safety, efficacy, and short-term follow-up","volume":"7","author":"K\u00fchn AL","year":"2015","unstructured":"K\u00fchn AL, Hou SY, Perras M, Flow diverter stents for unruptured saccular anterior circulation perforating artery aneurysms: safety, efficacy, and short-term follow-up. J Neurointerv Surg. 2015;7(9):634\u2013640."},{"issue":"12","key":"b10","series-title":"J Neurointerv Surg","first-page":"e35","article-title":"Intermediate catheter placement distal to the cerebral aneurysm during flow diversion embolization with the Surpass device","volume":"10","author":"Topcuoglu OM","year":"2018","unstructured":"Topcuoglu OM, Arat A, Peker A, Sarikaya B. Intermediate catheter placement distal to the cerebral aneurysm during flow diversion embolization with the Surpass device. J Neurointerv Surg. 2018;10(12):e35."},{"issue":"1","key":"b11","series-title":"J Cerebrovasc Endovasc Neurosurg","first-page":"47","article-title":"Anterior choroidal artery aneurysms: influence of regional microsurgical anatomy on safety of endovascular treatment","volume":"20","author":"Ghali MGZ","year":"2018","unstructured":"Ghali MGZ, Srinivasan VM, Wagner KM, Lam S, Johnson JN, Kan P. Anterior choroidal artery aneurysms: influence of regional microsurgical anatomy on safety of endovascular treatment. J Cerebrovasc Endovasc Neurosurg. 2018;20(1):47\u201352."},{"issue":"4","key":"b12","series-title":"J Neurosurg","first-page":"1064","article-title":"Patency of anterior circulation branch vessels after Pipeline embolization: longer-term results from 82 aneurysm cases","volume":"126","author":"Rangel-Castilla L","year":"2017","unstructured":"Rangel-Castilla L, Munich SA, Jaleel N, Patency of anterior circulation branch vessels after Pipeline embolization: longer-term results from 82 aneurysm cases. J Neurosurg. 2017;126(4):1064\u20131069."},{"issue":"4","key":"b13","series-title":"Asian J Neurosurg","first-page":"327","article-title":"The unusual angiographic course of intracranial pseudoaneurysms","volume":"10","author":"Zanaty M","year":"2015","unstructured":"Zanaty M, Chalouhi N, Jabbour P, Starke RM, Hasan D. The unusual angiographic course of intracranial pseudoaneurysms. Asian J Neurosurg. 2015;10(4):327\u2013330."},{"key":"b14","series-title":"J Clin Neurosci","first-page":"166","article-title":"Experience with FRED junior flow diverter in treatment of cerebral aneurysms at or distal to the circle of Willis","volume":"69","author":"Sivasankar R","year":"2019","unstructured":"Sivasankar R, Shrivastava M, Limaye US. Experience with FRED junior flow diverter in treatment of cerebral aneurysms at or distal to the circle of Willis. J Clin Neurosci. 2019;69:166\u2013169."},{"issue":"6","key":"b15","series-title":"J Neurosurg Sci","first-page":"702","article-title":"Flow diversion for small caliber vessel aneurysms: efficacy, safety, and functional outcome","volume":"63","author":"Sweid A","year":"2019","unstructured":"Sweid A, Starke RM, Herial N, Flow diversion for small caliber vessel aneurysms: efficacy, safety, and functional outcome. J Neurosurg Sci. 2019;63(6):702\u2013713."},{"key":"b16","series-title":"World Neurosurg","first-page":"e193","article-title":"Tiny pipes: 67 cases of flow diversion for aneurysms in distal vessels measuring less than 2.0 mm","volume":"127","author":"Bender MT","year":"2019","unstructured":"Bender MT, Zarrin DA, Campos JK, Tiny pipes: 67 cases of flow diversion for aneurysms in distal vessels measuring less than 2.0 mm. World Neurosurg. 2019;127:e193\u2013e201."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/6\/7\/article-CASE2386.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/6\/7\/article-CASE2386.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/6\/7\/article-CASE2386.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T14:34:18Z","timestamp":1770302058000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/6\/7\/article-CASE2386.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,14]]},"references-count":32,"journal-issue":{"issue":"7"},"URL":"https:\/\/doi.org\/10.3171\/case2386","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,14]]}}}