Failure of aneurysm occlusion by flow diverter: a role for surgical bypass and parent artery occlusion

Flow diverters represent a paradigm shift in the treatment of aneurysms. However, unusual and poorly understood complications are being reported. We present a case of a giant internal carotid artery terminus aneurysm treated with flow diversion that progressively and symptomatically enlarged despite a reduction in the filling portion. Complete occlusion of the aneurysm and reduction in mass effect occurred through superficial temporal artery- middle cerebral artery bypass and parent artery occlusion. Incomplete aneurysm occlusion following flow diversion has been reported, but mechanisms and predisposing factors are speculative and definitive solutions have not been described. This case illustrates a potential solution.