• Flow diverter in the treatment of MCA aneurysms:

During this third episode we begin with some important topics discussed by Pr. René Chapot:

1) Should we use such a powerful device to treat aneurysms of this type?

2) Would covering a branch using an FD in that region be a high price to treat an aneurysm?

Furthermore, he recalls that we perform several angioplasties for stenosis of intracranial arteries and when we evaluate the use of FD we say that we do not mind sacrificing a branch.

Another discussion raised by Pr. Berenstein is the possibility of doing an occlusion test to find out which branch of the MCA has the best collateral to define which branch we should place the FD. 

And in addition to this discussion, Pr. Chapot remembers that a great possibility that is very reproducible anywhere in the world is the surgical approach. This was corroborated by Pr. Siddiqui who emphasized that in his service this would have been the option. 

And Pr. Chapot treated this MCA aneurysm with two scepter balloons and emphasized the need to occlude the balloon orifice with heat to avoid blood entry that could lead to serious complications.

• Further reading:

1) Piano, M. et al. Flow diverter devices in the treatment of complex middle cerebral artery aneurysms when surgical and endovascular treatments are challenging. J. Stroke Cerebrovasc. Dis. 31, 106760 (2022)

2) BhogalP,AlMatterM,Ba ̈ znerH,etal.Flowdiversionforthetreat- ment of MCA bifurcation aneurysms: a single centre experience. Front Neurol 2017;8:20 CrossRef Medline

3) BhogalP,MartinezR,GansladtO,etal.Managementofunruptured saccular aneurysms of the M1 segment with flow diversion: a single centre experience. Clin Neuroradiol 2016 Dec 11. [Epub ahead of print] CrossRef Medline

4) Briganti F, Napoli M, Leone G, et al. Treatment of intracranial an- eurysms by flow diverter devices: long-term results from a single center. Eur J Radiol 2014;83:1683 90 CrossRef Medline