Stent-assisted coil embolization of a fenestration-related aneurysm of an infraoptic anterior cerebral artery: A case report.

Background: An infraoptic course of the anterior cerebral artery (ACA) is a rare congenital vascular anomaly that may be associated with intracranial aneurysms and other segmental anomalies. The endovascular experience in this setting remains limited. Case Description: A 66-year-old man was incidentally found to have an unruptured 8.0-mm aneurysm arising at the proximal apex of a fenestrated left infraoptic ACA. The precommunicating segment of the left infraoptic ACA formed a fenestration whose thick left and thin right limbs each gave rise to an A2 segment before rejoining into a common trunk that continued as a well-developed median artery of the corpus callosum (MACC); the right A1 and right A2 segments were hypoplastic. A second 2.5-mm aneurysm was present on the thick left limb between the left A2 origin and the MACC. Stent-assisted coil embolization was performed with a Neuroform Atlas stent deployed from the MACC through the thick left limb into the left infraoptic ACA, achieving complete occlusion of the larger aneurysm while the thick left limb and its branches were preserved and the thin right limb was not opacified. Confirmatory digital subtraction angiography at 12 months demonstrated stable complete occlusion, a patent stent without in-stent stenosis, and no interval change in the untreated smaller aneurysm. Conclusion: Stent-assisted coil embolization is a feasible treatment for a fenestration-related aneurysm of an infraoptic ACA, achieving durable complete occlusion with preservation of the dominant parent pathway.