Case Report: PipelineTM Flex flow diverter for an unruptured MCA Bifurcation Aneurysm and parent artery stenosis with 49 months follow-up

Background The effective treatment of middle cerebral artery (MCA) bifurcation aneurysms remains challenging and is often prone to complications when treating aneurysms in these sites. FDs treatment for MCA bifurcation aneurysms is feasible, with comparable safety and efficacy profiles to other available endovascular options when utilized in carefully selected aneurysms. At the same time, the FDs demonstrated satisfactory performance in terms of periprocedural complications, favorable clinical outcomes, and complete occlusion on follow-up imaging in the management of intracranial aneurysms accompanied by parent artery stenosis. However, there is little data to support FDs treatment for middle cerebral bifurcation aneurysms combined with parent artery stenosis. Case presentation A 54-year-old male patient came to hospital for treatment due to repeated left limb weakness and had a history of hypertension for more than 10 years. Complete digital subtraction angiography (DSA) confirmed that there was local severe stenosis in the M1 segment of the right middle cerebral artery, and an aneurysm formed at the distal bifurcation. The preoperative diagnosis was TIA and an aneurysm in the middle bifurcation of the right side of the brain. The patient was treated with balloon dilation and injection of a flow-diverter device for the treatment of bifurcation aneurysm and stenosis. Patients should take medication regularly before and after surgery and have regular follow-up. During the 49-month postoperative follow-up, the patient did not experience ischemic events or aneurysm recurrence. Conclusions FDs’ treatment is feasible in patients with bifurcation aneurysms of the middle cerebral artery with stenosis of the parent artery, and for bifurcation aneurysms, the safety and efficacy of FDs’ treatment is comparable to other available endovascular options. At the same time, for parent artery stenosis, it has shown satisfactory performance in terms of perioperative complications, good clinical outcomes, and complete occlusion on subsequent imaging.