Abstract
OBJECTIVE: Giant anterior cerebral artery (ACA) aneurysms are rare and technically challenging to manage. Surgical approaches are highly demanding, and the associated complication rates are not necessarily low. Conventional endovascular techniques often fail to achieve durable occlusion. The Flow-Redirection Endoluminal Device (FRED; Terumo Neuro, Aliso Viejo, CA, USA) has demonstrated efficacy in other intracranial locations; however, its use in giant ACA aneurysms has not been previously reported. CASE PRESENTATION: A 64-year-old woman presented with frontal lobe aphasia. Imaging revealed a giant thrombosed aneurysm in the left A1-A2 segment with perianeurysmal edema. She was treated with a FRED device. Due to severe deformation of the left A1 segment, a 5Fr SOFIASELECT distal access catheter (Terumo Neuro) was used to navigate the tortuous anatomy and facilitate device delivery. Complete occlusion of the aneurysm was confirmed at 5 months. MRI demonstrated progressive shrinkage of the aneurysm and resolution of edema, with no neurological deficits observed at 23 months. CONCLUSION: This case suggests that giant ACA aneurysms may be successfully treated with flow diversion using the FRED. The use of a distal access catheter capable of reaching the A1 segment appeared to be important for achieving stable device deployment and complete occlusion, highlighting its potential role in complex anterior circulation interventions.