Distal Anterior Cerebral Artery Aneurysms

Lehečka, Martin; Dashti, Reza; Lehto, Hanna; Kivisaari, Riku; Niemelä, Mika; Hernesniemi, Juha

doi:10.1007/978-3-211-99373-6_3

Cited by 42 publications

(36 citation statements)

References 144 publications

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“…3,13) However, this approach demands expert surgical skills. Most importantly, an interdisciplinary treatment selection provides the best chance of obtaining better long-term clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Coiling as the First Treatment Strategy for Ruptured Pericallosal Artery Aneurysms: Results, Complications, and Follow Up

Yamazaki

Sonobe

Kato

et al. 2013

Neurol. Med. Chir.(Tokyo)

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We apply endovascular coiling as the first treatment option for ruptured pericallosal artery aneurysms. We conducted a retrospective analysis of the clinical and radiological outcomes of this treatment strategy and morphological factors associated with the success of endovascular coiling, to assess the safety and feasibility of our management strategy. From January 2003 to January 2012, we attempted endovascular coiling as the first-intention treatment for 30 consecutive patients with ruptured pericallosal artery aneurysms including those with intracerebral hematoma. Twenty-seven cases of ruptured pericallosal artery aneurysms were successfully embolized with coiling whereas three failures required surgery. Four patients experienced periprocedural complications including thromboembolic event in two and hematoma enlargement after coiling in two. A maximum aneurysm diameter of º3 mm was most strongly associated with failure of endovascular coiling. Of the 27 coil-treated aneurysms, immediate angiographic results showed complete aneurysm occlusion in 19 cases, neck remnant in 6, and residual aneurysm in 2. One patient had a major aneurysm recurrence that was uneventfully reembolized. Sixteen of our 30 patients had good outcomes (modified Rankin scale [mRS] 0-2), 7 had moderate disability (mRS 3), and 4 had severe disability (mRS 4-5) at 3 months after treatment. The management strategy for coiling as the first-intention treatment for ruptured pericallosal artery aneurysms has the potential to become an acceptable alternative to surgical clipping for selected cases, although a larger study population and longer follow-up periods are needed before definitive conclusions can be drawn.

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Section: Discussionmentioning

confidence: 99%

Endovascular Coiling as the First Treatment Strategy for Ruptured Pericallosal Artery Aneurysms: Results, Complications, and Follow Up

Yamazaki

Sonobe

Kato

et al. 2013

Neurol. Med. Chir.(Tokyo)

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“…Patient selection and individualized care that optimizes institutional and operator expertise are crucial, as microsurgical and endovascular strategies are not mutually exclusive but rather complementary. [82][83][84][85] Worse clinical grade at presentation [64,86,87] Vasospasm at presentation [64,86,87] Significant comorbidities (i.e., atherosclerosis) [88,89] Clipping Very small aneurysms (≤3 mm) [90] Middle cerebral artery aneurysms [86,91,92] Distal anterior cerebral artery aneurysms [93] Presentation with large intraparenchymal hematomas (>50 mL) [91] Young patients [94] …”

Section: Resultsmentioning

confidence: 99%

“…This is due to several reasons including their frequent broad-based configuration or unfavorable geometry for coil packing, the small caliber of surrounding branches, increased likelihood of recurrence due to their bifurcation location, and ease of direct surgical access. Microsurgical treatment of distal anterior cerebral artery aneurysms is often preferred due to their peripheral location, small size, and unfavorable neck-to-parent artery ratio [93]. Patients that present with large intraparenchymal hematomas (>50 mL) may benefit with microsurgical clipping since improved outcomes occur with hematoma evacuation within 3.5 h [91].…”

Section: Patient Selectionmentioning

confidence: 98%

Treatment of Intracranial Aneurysms: Clipping Versus Coiling

Liu

Huang

2015

Curr Cardiol Rep

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Intracranial aneurysms (IAs) have an estimated incidence of up to 10 % and can lead to serious morbidity and mortality. Because of this, the natural history of IAs has been studied extensively, with rupture rates ranging from 0.5 to 7 %, depending on aneurysm characteristics. The spectrum of presentation of IAs ranges from incidental detection to devastating subarachnoid hemorrhage. Although the gold standard imaging technique is intra-arterial digital subtraction angiography, other modalities such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are being increasingly used for screening and treatment planning. Management of these patients depends upon a number of factors including aneurysmal, patient, institutional, and operator factors. The ultimate goal of treating patients with IAs is complete and permanent occlusion of the aneurysm sac in order to eliminate future hemorrhagic risk, while preserving or restoring the patient's neurological function. The most common treatment approaches include microsurgical clipping and endovascular coiling, and multiple studies have compared these two techniques. To date, three large prospective, randomized studies have been done: a study from Finland, International Subarachnoid Aneurysm Trial (ISAT), and the Barrow Ruptured Aneurysm Trial (BRAT). Despite differences in methodology, the results were similar: in patients undergoing coiling, although rates of rebleeding and retreatment are higher, the overall rate of poor outcomes at 12 months was significantly lower. As minimally invasive procedures and devices continue to be refined, endovascular strategies are likely to increase in popularity. However, as long-term outcome studies become available, it is increasingly apparent that they are complementary treatment strategies, with patient selection of critical importance.

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“…Distal anterior serebral arter (DASA) anevrizmaları; anterior komünikan arter distalinde anterior serebral arterin A2-A5 segmentlerine lokalize olmuş anevrizmalardır ve bu anevrizmaların cerrahi tedavisinde zorluklar yaşanabilmektedir (1,2,3,4). Willis poligonu anevrizmalarının cerrahisinde kolaylıkla BOS drenajı sağlanabilirken DASA anevrizmalarında bu pek mümkün olmadığından interhemisferik diseksiyonda güçlükler yaşanabilmektedir.…”

Section: Introductionunclassified

“…Willis poligonu anevrizmalarının cerrahisinde kolaylıkla BOS drenajı sağlanabilirken DASA anevrizmalarında bu pek mümkün olmadığından interhemisferik diseksiyonda güçlükler yaşanabilmektedir. Bunun dışında köprü venlerinin bulunması, cerrahi çalışma alanın dar olması, anevrizmanın singulat girusa yapışık olması, anevrizma boynunun geniş, sklerotik, frajil olması ve prematur anevrizma rüptürü DASA anevrizma cerrahisini ve prognozu etkileyen önemli faktörlerdir (2,3,4,5,6 31 yaşında erkek olgu, baş ağrısı şikayeti ile başvurdu. Hant-Hess puanı 1, intraserebral hemoraji mevcuttu.…”

Section: Introductionunclassified