Posterior Cerebral Artery Aneurysm: Endovascular Treatment of a Fusiform, Partially Thrombosed P2-Aneurysm with a Dual-Layer Flow-Diverting Stent (FRED) in a Young Patient with Good Clinical Outcome

  • Dominik F. Vollherbst
  • Markus A. MöhlenbruchEmail author
Living reference work entry


A 15-year-old male patient presented with a fusiform, partially thrombosed aneurysm located in the P2 segment of the right posterior cerebral artery (PCA). The aneurysm had become clinically apparent 6 months before treatment as a small hemorrhage in the right cerebral peduncle caused transient paresis in the patient’s left hand. Endovascular treatment was performed with a dual-layer Flow-Redirection Intraluminal Device (FRED Jr.; MicroVention) flow diverter. During the follow-up period, the aneurysm substantially decreased in size until it had completely thrombosed. The treatment of intracranial aneurysms using dual-layer flow diverters (FRED and FRED Jr.; MicroVention) is the main topic of this chapter.


Posterior cerebral artery Flow diverter FRED Dissecting aneurysm 


  1. Becske T, Kallmes DF, Saatci I, McDougall CG, Szikora I, Lanzino G, Moran CJ, Woo HH, Lopes DK, Berez AL, Cher DJ, Siddiqui AH, Levy EI, Albuquerque FC, Fiorella DJ, Berentei Z, Marosfoi M, Cekirge SH, Nelson PK. Pipeline for uncoilable or failed aneurysms: results from a multicenter clinical trial. Radiology. 2013;267(3):858–68. Scholar
  2. Brinjikji W, Murad MH, Lanzino G, Cloft HJ, Kallmes DF. Endovascular treatment of intracranial aneurysms with flow diverters: a meta-analysis. Stroke. 2013;44(2):442–7. Scholar
  3. Byrne JV, Beltechi R, Yarnold JA, Birks J, Kamran M. Early experience in the treatment of intra-cranial aneurysms by endovascular flow diversion: a multicentre prospective study. PLoS One. 2010;5(9). pii: e12492. Scholar
  4. Fiorella D, Woo HH, Albuquerque FC, Nelson PK. Definitive reconstruction of circumferential, fusiform intracranial aneurysms with the pipeline embolization device. Neurosurgery. 2008;62(5):1115–20.; discussion 1120–1CrossRefPubMedGoogle Scholar
  5. Kallmes DF, Brinjikji W, Boccardi E, Ciceri E, Diaz O, Tawk R, Woo H, Jabbour P, Albuquerque F, Chapot R, Bonafe A, Dashti SR, Delgado Almandoz JE, Given C 2nd, Kelly ME, Cross DT 3rd, Duckwiler G, Razack N, Powers CJ, Fischer S, Lopes D, Harrigan MR, Huddle D, Turner R 4th, Zaidat OO, Defreyne L, Pereira VM, Cekirge S, Fiorella D, Hanel RA, Lylyk P, McDougall C, Siddiqui A, Szikora I, Levy E. Aneurysm Study of Pipeline in an Observational Registry (ASPIRe). Interv Neurol. 2016;5(1–2):89–99. Scholar
  6. Killer-Oberpfalzer M, Kocer N, Griessenauer CJ, Janssen H, Engelhorn T, Holtmannspötter M, Buhk JH, Finkenzeller T, Fesl G, Trenkler J, Reith W, Berlis A, Hausegger K, Augustin M, Islak C, Minnich B, Möhlenbruch M. European multicenter study for the evaluation of a dual-layer flow-diverting stent for treatment of wide-neck intracranial aneurysms: The European Flow-Redirection Intraluminal Device Study. AJNR Am J Neuroradiol. 2018;39(5):841–7. Scholar
  7. Kulcsár Z, Houdart E, Bonafé A, Parker G, Millar J, Goddard AJ, Renowden S, Gál G, Turowski B, Mitchell K, Gray F, Rodriguez M, van den Berg R, Gruber A, Desal H, Wanke I, Rüfenacht DA. Intra-aneurysmal thrombosis as a possible cause of delayed aneurysm rupture after flow-diversion treatment. AJNR Am J Neuroradiol. 2011;32(1):20–5. Scholar
  8. Lubicz B, Collignon L, Raphaeli G, Pruvo JP, Bruneau M, De Witte O, Leclerc X. Flow-diverter stent for the endovascular treatment of intracranial aneurysms: a prospective study in 29 patients with 34 aneurysms. Stroke. 2010;41(10):2247–53. Scholar
  9. Lv X, Yang H, Liu P, Li Y. Flow-diverter devices in the treatment of intracranial aneurysms: a meta-analysis and systematic review. Neuroradiol J. 2016;29(1):66–71. Scholar
  10. McAuliffe W, Wycoco V, Rice H, Phatouros C, Singh TJ, Wenderoth J. Immediate and midterm results following treatment of unruptured intracranial aneurysms with the Pipeline Embolization Device. AJNR Am J Neuroradiol. 2012;33(1):164–70. Scholar
  11. Möhlenbruch MA, Herweh C, Jestaedt L, Stampfl S, Schönenberger S, Ringleb PA, Bendszus M, Pham M. The FRED flow-diverter stent for intracranial aneurysms: clinical study to assess safety and efficacy. AJNR Am J Neuroradiol. 2015;36(6):1155–61. Scholar
  12. Möhlenbruch MA, Kizilkilic O, Killer-Oberpfalzer M, Baltacioglu F, Islak C, Bendszus M, Cekirge S, Saatci I, Kocer N. Multicenter experience with FRED Jr Flow Re-Direction Endoluminal Device for intracranial aneurysms in small arteries. AJNR Am J Neuroradiol. 2017;38(10):1959–65. Scholar
  13. Peschillo S, Caporlingua A, Resta MC, Peluso JPP, Burdi N, Sourour N, Diana F, Guidetti G, Clarençon F, Bloemsma GC, Di Maria F, Donatelli M, Resta M. Endovascular treatment of large and giant carotid aneurysms with flow-diverter stents alone or in combination with coils: a multicenter experience and long-term follow-up. Oper Neurosurg (Hagerstown). 2017;13(4):492–502. Scholar
  14. Pierot L, Spelle L, Berge J, Januel AC, Herbreteau D, Aggour M, Piotin M, Biondi A, Barreau X, Mounayer C, Papagiannaki C, Lejeune JP, Gauvrit JY, Derelle AL, Chabert E, Costalat V. SAFE study (Safety and efficacy Analysis of FRED Embolic device in aneurysm treatment): 1-year clinical and anatomical results. J Neurointerv Surg. 2019;11(2):184–9. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Dominik F. Vollherbst
    • 1
  • Markus A. Möhlenbruch
    • 1
    Email author
  1. 1.Department of NeuroradiologyHeidelberg University HospitalHeidelbergGermany

Personalised recommendations