X-configuration Pipeline Flex embolization device for complex anterior communicating artery aneurysm: illustrative case.

Abstract

<h4>Background</h4>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.<h4>Observations</h4>An adult patient with a complex 11.21 × 14.28-mm ACoA aneurysm involving bilateral A1-A2 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.<h4>Lessons</h4>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. https://thejns.org/doi/10.3171/CASE25415.