Large anterior communicating artery aneurysm successfully obliterated by straightening the parent artery: an illustrative case

• We report a case in which a large anterior communicating artery (Acom) aneurysm (left A1–A2 junction) with a hairpin-shaped parent artery was completely occluded by straightening the parent artery using a neck-bridging stent. This report highlights importance of use of a neck-bridging stent to straighten angulation of the parent artery in refractory large Acom aneurysms suggests a potential method for preventing aneurysm recurrence. Endovascular devices for cerebral aneurysms have advanced, but large aneurysms with complex shapes remain difficult to cure. A steep branching angle for the parent artery can be a key factor in recurrence after endovascular treatment. We report a case in which a large anterior communicating artery (Acom) aneurysm (left A1–A2 junction) with a hairpin-shaped parent artery was completely occluded by straightening the parent artery using a neck-bridging stent. The patient in his 60 s was referred to our department after cerebral magnetic resonance imaging (MRI) in a dementia evaluation revealed a large Acom aneurysm 20 mm in diameter. Initial coil embolization was successful, but recurrence was observed six months later, requiring retreatment. After embolizing the recurrent aneurysm, a neck-bridging stent was placed in the left A1–A2 segment with a hairpin curve, successfully straightening the parent artery. The postoperative course was uneventful, with no hemorrhagic or ischemic complications, and the patient was discharged independently. No recurrence was observed on MRI a year later. This successful use of a neck-bridging stent to straighten angulation of the parent artery in refractory large Acom aneurysms suggests a potential method for preventing aneurysm recurrence.