Flow Remodeling in a Fusiform Distal Middle Cerebral Artery Aneurysm: A “Roundabout” Endovascular Treatment

Abstract Fusiform aneurysms of the distal middle cerebral artery (MCA) are rare and present unique treatment challenges. We present a rare case of a fusiform aneurysm, located in the M4 segment of the MCA, successfully treated with a low-profile braided stent monotherapy. The aneurysm, situated in the posterior superior temporal gyrus, demonstrated early contrast stagnation and favorable long-term remodeling. Follow-up angiography at 4 months revealed approximately 50% reduction in aneurysmal filling. At 15 months, complete aneurysm occlusion (O'Kelly-Marotta—D, indicating complete filling suppression) was achieved, with preserved parent vessel patency and no ischemic complications. This case highlights the feasibility of stent monotherapy for fusiform aneurysms in distal, eloquent MCA territories and underscores the value of braided flow-modulating stents in complex cerebrovascular anatomy.