Endovascular Management of Intracranial Aneurysms on Distal Arterial Branches: Illustrative Case Series and Literature Retrospection

Abstract

Intracranial aneurysms located on distal arterial branches are sporadic and scarce. They account for 2%-7% of the middle cerebral artery and 0.7%-2.3% of the posterior cerebral artery aneurysms, where they mainly arise distally from the P2-related sites. Such aneurysms usually remain asymptomatic prior to rupture, making their diagnosis and management really demanding. Endovascular treatment comprising of different neurointerventional techniques is becoming the most operational up-to-date routine to approach distal cerebral branch aneurysms. In this single-institution case series, endovascular selective coiling and/or parent vessel occlusion resulted in successful and total aneurysmal exclusion from cerebral circulation, which brought good recovery. Hereby, we present an illustrative case series of distal arterial branch intracranial aneurysms, discussing their possible etiology and various endovascular management modalities. We also provide a literature retrospection concerned with this rare entity. In conclusion, due to their predisposition for rupture, distal branch intracranial aneurysms should be treated early and aggressively. We do believe that endovascular selective coil occlusion is the management method of choice, while parent vessel occlusion (with liquid embolics) is optimal when aneurysmal coiling cannot be achieved, or when distal cortical territory is well vascularized by strong collateral cerebral circulation.

Adaptive wireless millirobotic locomotion into distal vasculature

“…As a typical example, the distally cortical arteries are limited to safely and effectively access by catheters to treat various lesions and diseases around this region, such as acute ischemic stroke (AIS) 3 , 7 , 8 , aneurysm 9 , 10 , cerebral arteriovenous malformation (CAVM) 11 , 12 , dural arteriovenous fistulas (dAVFs) 13 , 14 , and brain tumors 15 , 16 . Particularly, most malignant primary brain tumors occur in the cerebral cortex, with the highest percentage of 26% developing in the frontal lobe 15 , and dAVFs and 86% of the CAVM occur in the cortical region 12 .…”

Repeated intracerebral hemorrhage after craniotomy for a distal middle cerebral artery aneurysm

“…Hence, craniotomy clipping is often selected as the main treatment. With the progress of neurovascular intervention techniques and methods, successful cases of endovascular treatment of DMCA have also been reported [2,3] . However, aneurysms located at the M4 segment of MCA at the end of the artery are often accompanied by ICH, limiting treatment options.…”

“…With the progress of neurovascular intervention techniques and methods, successful cases of endovascular treatment of DMCA have also been reported. [ 2 , 3 ] However, aneurysms located at the M4 segment of MCA at the end of the artery are often accompanied by ICH, limiting treatment options. Therefore, clipping or excision by craniotomy and hematoma removal are usually used to treat these aneurysms.…”

Hybrid Microsurgical and Endovascular Approach in the Treatment of Multiple Cerebral Aneurysms: an Illustrative Case Series in Correlation with Literature Data

“…Microsurgical clipping of intracranial ruptured and non-ruptured aneurysms has long been the gold standard, yet expansions in endovascular techniques have challenged this rapidly. Nowadays, such techniques are widely accepted as a possible treatment modality option for selected single, multiple, as well as distal branch intracranial aneurysms ( 7 ). Nevertheless, some aneurysms cannot be successfully treated by a single technique alone due to their particular anatomy, location, complexity and multiplicity.…”