{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:32:41Z","timestamp":1769725961561,"version":"3.49.0"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"13","license":[{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,9,29]]},"abstract":"\n BACKGROUND<\/jats:title>\n Complex anterior communicating artery (ACoA) aneurysms involving bilateral anterior cerebral arteries present significant challenges for stent-assisted coiling (SAC). Flow diversion (FD) devices offer a viable alternative for managing such anatomically complex lesions.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n An adult patient with a complex 11.21 \u00d7 14.28\u2013mm ACoA aneurysm involving bilateral A1\u2013A2 segments underwent FD using two Pipeline Flex embolization devices) deployed in an X-configuration. Conventional clipping or SAC was deemed unsuitable due to anatomical complexity. Postprocedural imaging demonstrated optimal device positioning with contrast retention within the aneurysm sac.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Follow-up at 3-month and 18-month intervals confirmed complete occlusion with favorable vascular remodeling and without complications, demonstrating the safety and efficacy of this strategy for anatomically challenging aneurysms.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25415<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25415","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:02:23Z","timestamp":1759795343000},"source":"Crossref","is-referenced-by-count":0,"title":["X-configuration Pipeline Flex embolization device for complex anterior communicating artery aneurysm: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0323-3183","authenticated-orcid":true,"given":"Hao","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yunpei","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yingang","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ge","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"8","key":"bib1","series-title":"Ann Med","first-page":"597","article-title":"Molecular basis and genetic predisposition to intracranial aneurysm","volume":"46","author":"Tromp","year":"2014","unstructured":"Tromp GWeinsheimer SRonkainen AKuivaniemi H.Molecular basis and genetic predisposition to intracranial aneurysm. Ann Med. 2014;46(8):597-606."},{"issue":"3","key":"bib2","series-title":"Lancet Neurol","first-page":"179","article-title":"Genetics of intracranial aneurysms","volume":"4","author":"Ruigrok","year":"2005","unstructured":"Ruigrok YMRinkel GJWijmenga C.Genetics of intracranial aneurysms. Lancet Neurol. 2005;4(3):179-189."},{"issue":"13","key":"bib3","series-title":"Dtsch Arztebl Int","first-page":"226","article-title":"Aneurysmal subarachnoid hemorrhage","volume":"114","author":"Petridis","year":"2017","unstructured":"Petridis AKKamp MACornelius JFAneurysmal subarachnoid hemorrhage. Dtsch Arztebl Int. 2017;114(13):226-236."},{"issue":"2","key":"bib4","series-title":"Mayo Clin Proc","first-page":"153","article-title":"Medical and surgical management of intracranial aneurysms","volume":"70","author":"Meyer","year":"1995","unstructured":"Meyer FBMorita APuumala MRNichols DA.Medical and surgical management of intracranial aneurysms. Mayo Clin Proc. 1995;70(2):153-172."},{"issue":"2","key":"bib5","series-title":"Interv Neuroradiol","first-page":"158","article-title":"The off-label uses of pipeline embolization device for complex cerebral aneurysms: mid-term follow-up in a single center","volume":"31","author":"Zhang","year":"2025","unstructured":"Zhang HRen JWang JLv X.The off-label uses of pipeline embolization device for complex cerebral aneurysms: mid-term follow-up in a single center. Interv Neuroradiol. 2025;31(2):158-167."},{"issue":"3","key":"bib6","series-title":"Chin Med J (Engl)","first-page":"367","article-title":"Computed tomography angiography in diagnosis and treatment of splenic artery aneurysm","volume":"129","author":"Wang","year":"2016","unstructured":"Wang CXGuo SLHan LNComputed tomography angiography in diagnosis and treatment of splenic artery aneurysm. Chin Med J (Engl). 2016;129(3):367-369."},{"issue":"4","key":"bib7","series-title":"J Neurosurg","first-page":"969","article-title":"Conventional and high-resolution vessel wall MRI of intracranial aneurysms: current concepts and new horizons","volume":"128","author":"Lehman","year":"2018","unstructured":"Lehman VTBrinjikji WMossa-Basha MConventional and high-resolution vessel wall MRI of intracranial aneurysms: current concepts and new horizons. J Neurosurg. 2018;128(4):969-981."},{"issue":"suppl 1","key":"bib8","series-title":"Neurosurgery","first-page":"177","article-title":"Modern paradigms for the treatment of ruptured anterior communicating artery aneurysms","volume":"62","author":"Moon","year":"2015","unstructured":"Moon KNakaji PAlbuquerque FCMcDougall CGSpetzler RF.Modern paradigms for the treatment of ruptured anterior communicating artery aneurysms. Neurosurgery. 2015;62(suppl 1):177-179."},{"issue":"11","key":"bib9","series-title":"Neurol Sci","first-page":"6399","article-title":"Predictors of flow diverter stent in large and giant unruptured intracranial aneurysms, single-center experience","volume":"43","author":"Abdelkhalek","year":"2022","unstructured":"Abdelkhalek HAbdelhameed EAZakarea AEl Malky I.Predictors of flow diverter stent in large and giant unruptured intracranial aneurysms, single-center experience. Neurol Sci. 2022;43(11):6399-6405."},{"issue":"4","key":"bib10","series-title":"Oper Neurosurg","first-page":"355","article-title":"Endovascular treatment of anterior circulation aneurysms with the p64 flow modulation device: mid- and long-term results in 617 aneurysms from a Single Center","volume":"20","author":"Aguilar P\u00e9rez","year":"2021","unstructured":"Aguilar P\u00e9rez MHenkes EHellstern VEndovascular treatment of anterior circulation aneurysms with the p64 flow modulation device: mid- and long-term results in 617 aneurysms from a Single Center. Oper Neurosurg. 2021;20(4):355-363."},{"issue":"2","key":"bib11","series-title":"J Korean Neurosurg Soc","first-page":"137","article-title":"The evolution of flow-diverting stents for cerebral aneurysms; historical review, modern application, complications, and future direction","volume":"63","author":"Shin","year":"2020","unstructured":"Shin DSCarroll CPElghareeb MHoh BLKim BT.The evolution of flow-diverting stents for cerebral aneurysms; historical review, modern application, complications, and future direction. J Korean Neurosurg Soc. 2020;63(2):137-152."},{"issue":"1","key":"bib12","series-title":"Neurosurgery","first-page":"e3","article-title":"Commentary: comparison of flow-redirection endoluminal device and pipeline embolization device in the treatment of intracerebral aneurysms","volume":"92","author":"Dagra","year":"2023","unstructured":"Dagra ALucke-Wold B.Commentary: comparison of flow-redirection endoluminal device and pipeline embolization device in the treatment of intracerebral aneurysms. Neurosurgery. 2023;92(1):e3-e4."},{"key":"bib13","series-title":"Front Neurol","first-page":"1050","article-title":"Single-center experience with the bare p48MW low-profile flow diverter and its hydrophilically covered version for treatment of bifurcation aneurysms in distal segments of the anterior and posterior circulation","volume":"11","author":"Schob","year":"2020","unstructured":"Schob SKl\u00e4ver MRichter CSingle-center experience with the bare p48MW low-profile flow diverter and its hydrophilically covered version for treatment of bifurcation aneurysms in distal segments of the anterior and posterior circulation. Front Neurol. 2020;11:1050."},{"key":"bib14","series-title":"Neurosci Insights","first-page":"26331055221117560","article-title":"The evolution of endovascular therapy for intracranial aneurysms: historical perspective and next frontiers","volume":"17","author":"Laurent","year":"2022","unstructured":"Laurent DLucke-Wold BLeary OThe evolution of endovascular therapy for intracranial aneurysms: historical perspective and next frontiers. Neurosci Insights. 2022;17:26331055221117560."},{"issue":"8","key":"bib1","series-title":"Ann Med","first-page":"597","article-title":"Molecular basis and genetic predisposition to intracranial aneurysm","volume":"46","author":"Tromp","year":"2014","unstructured":"Tromp GWeinsheimer SRonkainen AKuivaniemi H.Molecular basis and genetic predisposition to intracranial aneurysm. Ann Med. 2014;46(8):597-606."},{"issue":"3","key":"bib2","series-title":"Lancet Neurol","first-page":"179","article-title":"Genetics of intracranial aneurysms","volume":"4","author":"Ruigrok","year":"2005","unstructured":"Ruigrok YMRinkel GJWijmenga C.Genetics of intracranial aneurysms. Lancet Neurol. 2005;4(3):179-189."},{"issue":"13","key":"bib3","series-title":"Dtsch Arztebl Int","first-page":"226","article-title":"Aneurysmal subarachnoid hemorrhage","volume":"114","author":"Petridis","year":"2017","unstructured":"Petridis AKKamp MACornelius JFAneurysmal subarachnoid hemorrhage. Dtsch Arztebl Int. 2017;114(13):226-236."},{"issue":"2","key":"bib4","series-title":"Mayo Clin Proc","first-page":"153","article-title":"Medical and surgical management of intracranial aneurysms","volume":"70","author":"Meyer","year":"1995","unstructured":"Meyer FBMorita APuumala MRNichols DA.Medical and surgical management of intracranial aneurysms. Mayo Clin Proc. 1995;70(2):153-172."},{"issue":"2","key":"bib5","series-title":"Interv Neuroradiol","first-page":"158","article-title":"The off-label uses of pipeline embolization device for complex cerebral aneurysms: mid-term follow-up in a single center","volume":"31","author":"Zhang","year":"2025","unstructured":"Zhang HRen JWang JLv X.The off-label uses of pipeline embolization device for complex cerebral aneurysms: mid-term follow-up in a single center. Interv Neuroradiol. 2025;31(2):158-167."},{"issue":"3","key":"bib6","series-title":"Chin Med J (Engl)","first-page":"367","article-title":"Computed tomography angiography in diagnosis and treatment of splenic artery aneurysm","volume":"129","author":"Wang","year":"2016","unstructured":"Wang CXGuo SLHan LNComputed tomography angiography in diagnosis and treatment of splenic artery aneurysm. Chin Med J (Engl). 2016;129(3):367-369."},{"issue":"4","key":"bib7","series-title":"J Neurosurg","first-page":"969","article-title":"Conventional and high-resolution vessel wall MRI of intracranial aneurysms: current concepts and new horizons","volume":"128","author":"Lehman","year":"2018","unstructured":"Lehman VTBrinjikji WMossa-Basha MConventional and high-resolution vessel wall MRI of intracranial aneurysms: current concepts and new horizons. J Neurosurg. 2018;128(4):969-981."},{"issue":"suppl 1","key":"bib8","series-title":"Neurosurgery","first-page":"177","article-title":"Modern paradigms for the treatment of ruptured anterior communicating artery aneurysms","volume":"62","author":"Moon","year":"2015","unstructured":"Moon KNakaji PAlbuquerque FCMcDougall CGSpetzler RF.Modern paradigms for the treatment of ruptured anterior communicating artery aneurysms. Neurosurgery. 2015;62(suppl 1):177-179."},{"issue":"11","key":"bib9","series-title":"Neurol Sci","first-page":"6399","article-title":"Predictors of flow diverter stent in large and giant unruptured intracranial aneurysms, single-center experience","volume":"43","author":"Abdelkhalek","year":"2022","unstructured":"Abdelkhalek HAbdelhameed EAZakarea AEl Malky I.Predictors of flow diverter stent in large and giant unruptured intracranial aneurysms, single-center experience. Neurol Sci. 2022;43(11):6399-6405."},{"issue":"4","key":"bib10","series-title":"Oper Neurosurg","first-page":"355","article-title":"Endovascular treatment of anterior circulation aneurysms with the p64 flow modulation device: mid- and long-term results in 617 aneurysms from a Single Center","volume":"20","author":"Aguilar P\u00e9rez","year":"2021","unstructured":"Aguilar P\u00e9rez MHenkes EHellstern VEndovascular treatment of anterior circulation aneurysms with the p64 flow modulation device: mid- and long-term results in 617 aneurysms from a Single Center. Oper Neurosurg. 2021;20(4):355-363."},{"issue":"2","key":"bib11","series-title":"J Korean Neurosurg Soc","first-page":"137","article-title":"The evolution of flow-diverting stents for cerebral aneurysms; historical review, modern application, complications, and future direction","volume":"63","author":"Shin","year":"2020","unstructured":"Shin DSCarroll CPElghareeb MHoh BLKim BT.The evolution of flow-diverting stents for cerebral aneurysms; historical review, modern application, complications, and future direction. J Korean Neurosurg Soc. 2020;63(2):137-152."},{"issue":"1","key":"bib12","series-title":"Neurosurgery","first-page":"e3","article-title":"Commentary: comparison of flow-redirection endoluminal device and pipeline embolization device in the treatment of intracerebral aneurysms","volume":"92","author":"Dagra","year":"2023","unstructured":"Dagra ALucke-Wold B.Commentary: comparison of flow-redirection endoluminal device and pipeline embolization device in the treatment of intracerebral aneurysms. Neurosurgery. 2023;92(1):e3-e4."},{"key":"bib13","series-title":"Front Neurol","first-page":"1050","article-title":"Single-center experience with the bare p48MW low-profile flow diverter and its hydrophilically covered version for treatment of bifurcation aneurysms in distal segments of the anterior and posterior circulation","volume":"11","author":"Schob","year":"2020","unstructured":"Schob SKl\u00e4ver MRichter CSingle-center experience with the bare p48MW low-profile flow diverter and its hydrophilically covered version for treatment of bifurcation aneurysms in distal segments of the anterior and posterior circulation. Front Neurol. 2020;11:1050."},{"key":"bib14","series-title":"Neurosci Insights","first-page":"26331055221117560","article-title":"The evolution of endovascular therapy for intracranial aneurysms: historical perspective and next frontiers","volume":"17","author":"Laurent","year":"2022","unstructured":"Laurent DLucke-Wold BLeary OThe evolution of endovascular therapy for intracranial aneurysms: historical perspective and next frontiers. Neurosci Insights. 2022;17:26331055221117560."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/10\/13\/article-CASE25415.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/10\/13\/article-CASE25415.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/10\/13\/article-CASE25415.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:14:53Z","timestamp":1769685293000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/10\/13\/article-CASE25415.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,29]]},"references-count":28,"journal-issue":{"issue":"13"},"URL":"https:\/\/doi.org\/10.3171\/case25415","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,29]]}}}