case_images: PMC11344899_01
case_images: PMC11344899_02
case_images: Stage 1: Preoperative diagnostic cerebral angiography demonstrating anterior-posterior (AP) (a) and lateral (b) projections of the 4-mm right A1 segment aneurysm (black arrowheads). Middeployment lateral unsubtracted (c) view of PED Flex deployment (black arrowhead) and intermediate access catheter, Catalyst5. Roadmap (d) view following PED Flex deployment across the neck of the aneurysm (black arrowhead). Postoperative AP (e) projection of the PED (red arrowhead) deployed across the neck of the aneurysm, jailing the right MCA (blue arrowhead demonstrating patency of right MCA). Five-year follow-up angiogram AP (f) and lateral (g) view demonstrating complete aneurysm obliteration (white arrowhead) and reduced MCA (blue arrowhead) filling with no in-stent thrombosis, displacement, pseudoaneurysm, or dissection in the parent vessel, and (h) robust MCA pial collateralization from the ACA.. PED Flex: Pipeline Embolization Device Flex.
case_images: 10.1177_2050313X241274243-fig1.jpg
case_images: PMC11344899_07_10.1177_2050313X241274243-fig1.jpg
case_images: fig1-2050313X241274243
case_images: Angiographic follow-up two-months postoperatively revealed Raymond I obliteration of the aneurysm with robust ACA pial collateralization to the middle cerebral artery (MCA) territory (Figure 1(f)-(h)).
case_images: PMC11344899_03
case_images: Stage 2: Five-year follow-up angiogram AP (a) and lateral (b) views demonstrating de novo left A1-A2 junction aneurysm (black arrowheads). Intraoperative lateral roadmap views showing (c) the guide catheter in the cavernous ICA (green arrowhead) and distal access catheter in the supraclinoid ICA (blue arrowhead); (d) the SL-10 microcatheter containing the 200 cm floppy tip guide wire (yellow arrowhead) distal to the aneurysm after the delivery assist catheter was removed; (e) the XT-27 microcatheter inserted over the 300 cm floppy tip guide wire with straightening of the vessel architecture (white arrowhead). Intraoperative unsubtracted view demonstrating the Surpass Evolve in position during (f) and at near-maximal (g) deployment. Postdeployment subtracted AP (h) and lateral (i) views showing Surpass Evolve across the aneurysm neck demonstrating complete deployment with no hemorrhage, in-stent thrombosis, pseudoaneurysm, or dissection, and demonstrating complete patency of distal vasculature.. ICA: internal carotid artery.
case_images: 10.1177_2050313X241274243-fig2.jpg
case_images: PMC11344899_07_10.1177_2050313X241274243-fig2.jpg
case_images: fig2-2050313X241274243
case_images: Five-year follow-up angiography revealed the de novo left-sided 3-mm A1-A2 junction saccular aneurysm and stable right MCA collateralization with continued obliteration of the A1 segment aneurysm (Figure 2(a) and (b)).
case_images: PMC11344899_04
case_images: PMC11344899_05
case_images: Stage 1: Preoperative diagnostic cerebral angiography demonstrating anterior-posterior (AP) (a) and lateral (b) projections of the 4-mm right A1 segment aneurysm (black arrowheads). Middeployment lateral unsubtracted (c) view of PED Flex deployment (black arrowhead) and intermediate access catheter, Catalyst5. Roadmap (d) view following PED Flex deployment across the neck of the aneurysm (black arrowhead). Postoperative AP (e) projection of the PED (red arrowhead) deployed across the neck of the aneurysm, jailing the right MCA (blue arrowhead demonstrating patency of right MCA). Five-year follow-up angiogram AP (f) and lateral (g) view demonstrating complete aneurysm obliteration (white arrowhead) and reduced MCA (blue arrowhead) filling with no in-stent thrombosis, displacement, pseudoaneurysm, or dissection in the parent vessel, and (h) robust MCA pial collateralization from the ACA.. PED Flex: Pipeline Embolization Device Flex.
case_images: 10.1177_2050313X241274243-fig1.jpg
case_images: PMC11344899_07_10.1177_2050313X241274243-fig1.jpg
case_images: fig1-2050313X241274243
case_images: Angiographic follow-up two-months postoperatively revealed Raymond I obliteration of the aneurysm with robust ACA pial collateralization to the middle cerebral artery (MCA) territory (Figure 1(f)-(h)).
case_images: PMC11344899_06
case_images: Stage 2: Five-year follow-up angiogram AP (a) and lateral (b) views demonstrating de novo left A1-A2 junction aneurysm (black arrowheads). Intraoperative lateral roadmap views showing (c) the guide catheter in the cavernous ICA (green arrowhead) and distal access catheter in the supraclinoid ICA (blue arrowhead); (d) the SL-10 microcatheter containing the 200 cm floppy tip guide wire (yellow arrowhead) distal to the aneurysm after the delivery assist catheter was removed; (e) the XT-27 microcatheter inserted over the 300 cm floppy tip guide wire with straightening of the vessel architecture (white arrowhead). Intraoperative unsubtracted view demonstrating the Surpass Evolve in position during (f) and at near-maximal (g) deployment. Postdeployment subtracted AP (h) and lateral (i) views showing Surpass Evolve across the aneurysm neck demonstrating complete deployment with no hemorrhage, in-stent thrombosis, pseudoaneurysm, or dissection, and demonstrating complete patency of distal vasculature.. ICA: internal carotid artery.
case_images: 10.1177_2050313X241274243-fig2.jpg
case_images: PMC11344899_07_10.1177_2050313X241274243-fig2.jpg
case_images: fig2-2050313X241274243
case_images: Five-year follow-up angiography revealed the de novo left-sided 3-mm A1-A2 junction saccular aneurysm and stable right MCA collateralization with continued obliteration of the A1 segment aneurysm (Figure 2(a) and (b)).
case_images: PMC11344899_07
case_images: Stage 1: Preoperative diagnostic cerebral angiography demonstrating anterior-posterior (AP) (a) and lateral (b) projections of the 4-mm right A1 segment aneurysm (black arrowheads). Middeployment lateral unsubtracted (c) view of PED Flex deployment (black arrowhead) and intermediate access catheter, Catalyst5. Roadmap (d) view following PED Flex deployment across the neck of the aneurysm (black arrowhead). Postoperative AP (e) projection of the PED (red arrowhead) deployed across the neck of the aneurysm, jailing the right MCA (blue arrowhead demonstrating patency of right MCA). Five-year follow-up angiogram AP (f) and lateral (g) view demonstrating complete aneurysm obliteration (white arrowhead) and reduced MCA (blue arrowhead) filling with no in-stent thrombosis, displacement, pseudoaneurysm, or dissection in the parent vessel, and (h) robust MCA pial collateralization from the ACA.. PED Flex: Pipeline Embolization Device Flex.
case_images: 10.1177_2050313X241274243-fig1.jpg
case_images: PMC11344899_07_10.1177_2050313X241274243-fig1.jpg
case_images: fig1-2050313X241274243
case_images: Angiographic follow-up two-months postoperatively revealed Raymond I obliteration of the aneurysm with robust ACA pial collateralization to the middle cerebral artery (MCA) territory (Figure 1(f)-(h)).
case_images: Stage 2: Five-year follow-up angiogram AP (a) and lateral (b) views demonstrating de novo left A1-A2 junction aneurysm (black arrowheads). Intraoperative lateral roadmap views showing (c) the guide catheter in the cavernous ICA (green arrowhead) and distal access catheter in the supraclinoid ICA (blue arrowhead); (d) the SL-10 microcatheter containing the 200 cm floppy tip guide wire (yellow arrowhead) distal to the aneurysm after the delivery assist catheter was removed; (e) the XT-27 microcatheter inserted over the 300 cm floppy tip guide wire with straightening of the vessel architecture (white arrowhead). Intraoperative unsubtracted view demonstrating the Surpass Evolve in position during (f) and at near-maximal (g) deployment. Postdeployment subtracted AP (h) and lateral (i) views showing Surpass Evolve across the aneurysm neck demonstrating complete deployment with no hemorrhage, in-stent thrombosis, pseudoaneurysm, or dissection, and demonstrating complete patency of distal vasculature.. ICA: internal carotid artery.
case_images: 10.1177_2050313X241274243-fig2.jpg
case_images: PMC11344899_07_10.1177_2050313X241274243-fig2.jpg
case_images: fig2-2050313X241274243
case_images: Five-year follow-up angiography revealed the de novo left-sided 3-mm A1-A2 junction saccular aneurysm and stable right MCA collateralization with continued obliteration of the A1 segment aneurysm (Figure 2(a) and (b)).
case_images: PMC11344899_08
case_images: Six-month follow-up subtracted AP (a) and lateral (b) views demonstrating the Surpass Evolve in place (red arrowhead), complete resolution of aneurysm (white arrowhead), and no in-stent thrombosis, pseudoaneurysm, or dissection. Subtracted (c) AP and (d) lateral views of the left internal carotid artery demonstrating no evidence of dissection.
case_images: 10.1177_2050313X241274243-fig3.jpg
case_images: PMC11344899_08_10.1177_2050313X241274243-fig3.jpg
case_images: fig3-2050313X241274243
case_images: Six-month angiographic follow-up revealed Raymond I aneurysm obliteration (Figure 3(a) and (b)). Clinically, the patient remained neurologically intact (Figure 3(c) and (d)).