ArticleSurgical neurology international2026
Ischemic complication in the anterior thalamoperforating artery territory following flow diverter stent placement for an internal carotid-posterior communicating artery aneurysm.
Article in Surgical neurology international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Flow diverter stents are widely used for internal carotid-posterior communicating artery (IC-PC) aneurysms, and covered branches such as the posterior communicating artery (PcomA) generally remain patent. Branches arising directly from the aneurysm dome, however, occupy a distinct anatomical position and may behave differently. Case Description: A woman in her 50s underwent Pipeline Flex with Shield Technology placement (5.0 × 16 mm) for a 9.2-mm wide-necked right IC-PC aneurysm. A thin branch arising directly from the aneurysm dome was preoperatively interpreted as a hypoplastic PcomA, with anticipated collateral support from an adequate ipsilateral P1 segment. Preoperative platelet function testing revealed clopidogrel non-response (adenosine diphosphate inhibition, 7.6%). On postoperative day 4, the patient developed left hemiparesis. Diffusion-weighted imaging demonstrated acute infarction in the right anterolateral thalamus, while digital subtraction angiography confirmed complete aneurysm thrombosis with disappearance of the branch and a fully patent stent. Vertebral artery angiography showed no retrograde filling of the PcomA. The hemiparesis resolved rapidly, but visuospatial and attentional-executive deficits persisted; the modified Rankin Scale score remained 2 at 18 months. Conclusion: When a hypoplastic PcomA arising from the aneurysm dome functions as a dominant terminal feeder of the anterior thalamoperforating artery, progressive intra-aneurysmal thrombosis after flow diversion may cause thalamic infarction-a risk incompletely addressed by antiplatelet optimization alone. An adequate P1 segment does not guarantee perfusion of such a dome-originating perforator. Preoperative functional assessment of collateral supply and branch-preserving alternatives merit consideration in this configuration.
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