Neurointervention.  2013 Sep;8(2):87-91. 10.5469/neuroint.2013.8.2.87.

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

• Park HS
• Kwon SC
• Kim MH
• Park ES
• Sim HB
• Lyo IU

• KMID: 1784024
• DOI: http://doi.org/10.5469/neuroint.2013.8.2.87

Abstract

PURPOSE
This study is an overview of the clinical and angiographic outcomes of patients who undergo treatment for distal anterior cerebral artery aneurysms.
MATERIALS AND METHODS
Between 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.
RESULTS
The 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).
CONCLUSION
Despite a comparatively high recurrence rate, the endovascular treatment of distal anterior cerebral aneurysms is feasible and has a good clinical outcome.

Keyword

Distal anterior cerebral artery; Aneurysm; Endovascular coil embolization; Recurrence

MeSH Terms

Aneurysm
Angiography
Anterior Cerebral Artery
Follow-Up Studies
Hemorrhage
Humans
Intracranial Aneurysm
Recurrence
Retrospective Studies
Rupture
Subarachnoid Space
Thromboembolism

Reference

1. Cavalcanti DD, Abla AA, Martirosyan NL, McDougall CG, Spetzler RF, Albuquerque FC. Endovascular management of distal ACA aneurysms: single-institution clinical experience in 22 consecutive patients and literature review. AJNR Am J Neuroradiol. 2013; 2. 07. [Epub ahead of print].

2. Suzuki S, Kurata A, Yamada M, Iwamoto K, Nakahara K, Sato K, et al. Outcomes analysis of ruptured distal anterior cerebral artery aneurysms treated by endosaccular embolization and surgical clipping. Interv Neuroradiol. 2011; 17:49–57. PMID: 21561558.

3. Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, et al. International Subarachnoid Aneurysm Trial(ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized trial. J Stroke Cerebrovasc Dis. 2002; 11:304–314. PMID: 17903891.

4. Roy D, Milot G, Raymond J. Endovascular treatment of unruptured aneurysms. Stroke. 2001; 32:1998–2004. PMID: 11546888.

5. Vallée JN, Pierot L, Bonafé A, Turjman F, Flandroy P, Berge J, et al. Endovascular treatment of intracranial wide-necked aneurysms using three-dimensional coils: predictors of immediate anatomic and clinical results. AJNR Am J Neuroradiol. 2004; 25:298–306. PMID: 14970036.

6. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke. 2003; 34:1398–1403. PMID: 12775880.

7. Rankin J. Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J. 1957; 2:200–215. PMID: 13432835.

8. Macleod MR, Davis SM, Mitchell PJ, Gerraty RP, Fitt G, Hankey GJ, et al. Results of a multicentre, randomised controlled trial of intra-arterial urokinase in the treatment of acute posterior circulation ischaemic stroke. Cerebrovasc Dis. 2005; 20:12–17. PMID: 15925877.

9. Menovsky T, van Rooij WJ, Sluzewski M, Wijnalda D. Coiling of ruptured pericallosal artery aneurysms. Neurosurgery. 2002; 50:11–14. PMID: 11844229.

10. Kim BM, Park SI, Kim DJ, Kim DI, Suh SH, Kwon TH, et al. Endovascular coil embolization of the auerysms with a branch incorporated into the sac. AJNR Am J Neuroradiol. 2010; 31:145–151. PMID: 19749218.

11. Raymond J, Roy D. Safety and efficacy of endovascular treatment of acutely ruptured aneurysms. Neurosurgery. 1997; 41:1235–1245. PMID: 9402574.

12. Regli L, Uske A, de Tribolet N. Endovascular coil placement compared with surgical clipping for the treatment of unruptured middle cerebral artery aneurysms:a consecutive series. J Neurosurg. 1999; 90:1025–1030. PMID: 10350247.

13. Nguyen TN, Raymond J, Roy D, Chagnon M, Weill A, Iancu-Gontard D, et al. Endovascular treatment of pericallosal aneurysms. J Neurosurg. 2007; 107:973–976. PMID: 17977269.

14. Vora N, Thomas AJ, Gupta R, Gologorsky Y, Panapitiya N, Jovin T, et al. Endovascular treatment of distal anterior cerebral artery aneurysms: technical results and review of the literature. J Neuroimaging. 2010; 20:70–73. PMID: 19018950.

15. Waldenberger P, Petersen J, Chemelli A, Schenk C, Gruber I, Strasak A, et al. Endovascular therapy of distal anterior cerebral artery aneurysms-an effective treatment option. Surg Neurol. 2008; 70:368–377. PMID: 18291498.

16. Gonzalez N, Sedrak M, Martin N, VinuelaF . Impact of anatomic features in the endovascular embolization of 181 anterior communicating artery aneurysms. Stroke. 2008; 39:2776–2782. PMID: 18617670.

17. Jin SC, Kwon do H, Ahn JS, Kwun BD, Song Y, Choi CG. Clinical and radiogical outcomes of endovascular detachable coil embolization in paraclinoid aneurysms : a 10-year experience. J Korean Neurosurg Soc. 2009; 45:5–10. PMID: 19242564.

18. Kim BM, Kim DI, Park SI, Kim DJ, Suh SH, Won YS. Coil embolization of unruptured middle cerebral artery aneurysms. Neurosurgery. 2011; 68:346–353. PMID: 21135721.

19. Tan IY, Agid RF, Willinsky RA. Recanalization rates after endovascular coil embolization in a cohort of matched ruptured and unruptured cerebral aneurysms. Interv Neuroradiol. 2011; 17:27–35. PMID: 21561556.

20. Piotin M, Spelle L, Mounayer C, Salles-Rezende MT, Giansante-Abud D, Vanzin-Santos R, et al. intracranial aneurysms: treatment with bare platinum coils--aneurysm packing, complex coils, and angiographic recurrence. Radiology. 2007; 243:500–508. PMID: 17293572.

21. Vallée JN, Pierot L, Mont'alverne F, Turjman F, Bonafé A, Bracard S, et al. Unruptured intracranial aneurysms treated by three-dimensional coil embolization: evaluation of the postoperative aneurysm occlusion volume. Neuroradiology. 2005; 47:438–445. PMID: 15906022.

22. Yagi K, Satoh K, Satomi J, Matsubara S, Nagahiro S. Evaluation of aneurysm stability after endovascular embolization with Guglielmi detachable coils: correlation between long-term stability and volume embolization ratio. Neurol Med Chir (Tokyo). 2005; 45:561–556. PMID: 16308514.