Endovascular Coil Embolization of Distal Anterior Cerebral Artery Aneurysms: Angiographic and Clinical Follow-up Results

Abstract

PurposeThis study is an overview of the clinical and angiographic outcomes of patients who undergo treatment for distal anterior cerebral artery aneurysms.Materials and MethodsBetween January 2009 and March 2012, 444 cerebral aneurysms were treated using endovascular coil embolization at our institute. Among them, 217 aneurysms were followed-up with angiography at least six months later. Of these, there were 16 distal anterior cerebral artery (ACA) aneurysms in 16 patients. We conducted a retrospective review of clinical and radiological follow-up results of all patients with distal ACA aneurysms. The clinical and angiographic outcomes were assessed using the modified Rankin scale (mRS) and the Raymond classification scale, respectively.ResultsThe mean age was 54.7 ± 10.2 years (41-75 years). The mean follow-up period was 20.6 ± 9.64 months (6-37 months). Three patients presented with acute rupture. The average aneurysm size was 4.98 ± 1.39 mm (3.0-8.1 mm), and eight of 16 aneurysms (50%) had aspect ratios < 2.0. All 16 patients presented with complete obliteration immediately after the procedure. However, two patients had procedure-related complications, one with coil extrusion to the subarachnoid space without hemorrhage and one with thromboembolism subsequent to chemical thrombolysis. In the follow-up angiography, one major and five minor recurrences (for a total of six recurrences, 37.5%) were detected. However, the differences between the ACA aneurysm group and others were not statistically significant. Clinical outcomes were good for all of the patients at the time of discharge (mean mRS: 0.25, 0 to 1) and at the follow-ups (mean mRS: 0).ConclusionDespite a comparatively high recurrence rate, the endovascular treatment of distal anterior cerebral aneurysms is feasible and has a good clinical outcome.

Endovascular treatment of distal anterior cerebral artery aneurysms: Long-term results

“…(3,20) However, we did see a very high proportion of major recanalizations (12 of 13 cases; 92.3%). In two other recently-reported series, (21,22) much lower rates of major recanalizations were reported, i.e., 16% and 25%, but we note that the populations of those studies, respectively 16 and 23 patients, were smaller than ours (92 patients).…”

Pericallosal Aneurysms: Effectiveness of Endovascular Management

“…3,9,17,19,20 Therefore, we need to be aggressive, without complication, even Sturiale demonstrated in a systematic review a rate nearly 7% of overall periprocedural rupture, with a procedure related morbidity rate of 8%, higher than that of other circle of Willis aneurysms. 7,[21][22][23] Comparing the technical challenges posed by the endovascular management and clipping, both techniques present difficulties. Pericallosal artery aneurysms at the bifurcation represent a special endovascular technical challenge given their distal location, commonly wide-neck morphology, small parent vessel diameter and potentially high recurrence rate after coiling given the bifurcation location.…”

Endovascular Therapy of Distal Anterior Cerebral Artery Aneurysms: Single-institution Clinical Experience with 47 Patients (49 Aneurysms)

“…It was reported that treatment with endovascular coiling caused a higher re-bleeding risk than surgical clipping in the International Subarachnoid Aneurysm Trial, 22) and DACA aneurysms tended to recur more often than with aneurysms in other locations. 23,24) We found that reoperation was needed in five cases of recanalization, but re-bleeding was not encountered. Endovascular coiling requires careful follow-up compared with surgical clipping.…”