Ischemic lesions in perforating arteries after flow diversion of middle cerebral aneurysms: a single-center cohort with MRI-monitored complications

In this single-center study, flow diversion for MCA aneurysms was associated with a measurable rate of lenticulostriate territory ischemia, most of which was clinically silent. The strong associations with metabolic comorbidities and the observed influence of device-vessel relationships highlight the importance of patient selection and vascular risk factor optimization. Prospective studies with standardized imaging and neurocognitive follow-up are warranted to clarify the long-term significance of asymptomatic ischemic lesions.