2024 Volume 33 Issue 1 Pages 19-26
Sidewall aneurysms include most internal carotid and vertebral artery aneurysms. The indications for flow diverters (FD) have been significantly relaxed by Japanese Ministry of Health, Labour and Welfare to include aneurysms with a maximum diameter of 5mm or more. Consequently, almost all sidewall aneurysms now qualify for insurance coverage, greatly expanding the range of treatment options. There is no doubt about the curative efficacy of FDs. They are particularly effective for paraclinoid internal carotid artery aneurysms, especially in younger patients. Therefore, it seems appropriate to consider FDs as the primary choice for such cases. Conversely, FDs are ineffective in some circumstances, such as in older patients or those with fetal-type posterior communicating artery aneurysms. For such cases, a casual choice of FD should be approached with caution, and other standard treatments should be thoroughly considered.