Mirror Image Distal Anterior Cerebral Artery Aneurysms Treated with Coil Embolization

Abstract

<jats:p> Mirror image aneurysms of the distal anterior cerebral arteries (DACA) are rare. To the best of our knowledge this is the first case report of two patients with mirror image DACA aneurysms treated successfully with coil embolization. The association of aneurysms with anatomic variants has been extensively reported. We may speculate that the remnants of the failed regression of the supreme anterior communicating artery could lead to an increase in stress across their territorial bifurcation, leading to the development of mirror image DACA aneurysms. We found the endovascular treatment of mirror image DACA aneurysms to be feasible and effective. If possible, we suggest the treatment of both aneurysms in one procedure. </jats:p>

Intracranial Mirror Aneurysms: Anatomic Characteristics and Treatment Options

“…According to Mehrotra et al ( 16 ), surgical clipping conferred better neurologic outcomes in 17 ruptured mirror aneurysms, with less intraoperative rupture, vasospasm, and infarction than in multiple non-mirror aneurysms. Wang et al ( 13 ) also studied patients with mirror aneurysms (n = 43), most of whom were treated by clipping (n = 39) rather than coil embolization (n = 4), and management of mirror aneurysms (clipping and coil embolization) has been detailed in some case series reports ( 14 17 18 19 20 ). However, unlike the limited patient numbers amassed in prior efforts, this study included the largest sampling of treated mirror aneurysms to date.…”

“…Despite abundance in the documentation on mirror aneurysms in terms of incidence, locations, and risk factors, only a few case reports and small-sized studies have addressed the management of mirror aneurysms ( 17 18 19 20 ). The purpose of this study was to investigate safety and feasibility of options for managing mirror aneurysms with emphasis on bilateral single-stage coil embolization.…”

Kissing aneurysms of the distal anterior cerebral artery: A case report and literature review

“…Furthermore, 'kissing' aneurysms are also associated with vascular structural changes, such as the anterior communicating artery complex (4,13). Vascular structural changes may induce the formation of aneurysms via influencing the hemodynamics, although certain researchers doubt the reason of hemodynamics (2).…”

“…Researchers have treated aneurysms with interventional embolization at the vertebrobasilar, middle cerebral, bilateral ophthalmic and anterior communicating arteries with favorable therapeutic effects (11,18,24,25). Although interventional embolization for the treatment of distal anterior cerebral aneurysms has been reported to be beneficial (13,26), thus far reports of this therapy on 'kissing' aneurysms of DACA are rare. The possible reasons are as follows: A number of cases of 'kissing' aneurysms at DACA were treated with interventional embolization and could not be diagnosed by imaging and their diagnosis was missed (10,16).…”

Three distal anterior cerebral artery aneurysms in the same branch associated with five additional intracranial aneurysms

“…The vast majority of published reports describe mirror type lesions originating from different pericallosal arteries. [ 2 4 11 13 ] One report showed coexistence of four DACA aneurysms with frontal arteriovenous malformation. Two aneurysms arose from the A2 segment of the right pericallosal artery, one from the right orbitofrontal artery, and another from the feeding vessel (frontopolar artery) of the malformation.…”