J Cerebrovasc Endovasc Neurosurg.  2014 Sep;16(3):247-253. 10.7461/jcen.2014.16.3.247.

Clinical Analysis and Surgical Considerations of Atherosclerotic Cerebral Aneurysms: Experience of a Single Center

• Park CK
• Shin HS
• Choi SK
• Lee SH
• Koh JS

• KMID: 1963163
• DOI: http://doi.org/10.7461/jcen.2014.16.3.247

Abstract

OBJECTIVE
Atherosclerotic cerebral aneurysms are known to increase occurrence of thromboembolic events and occlusion of perforator vessels intraoperatively due to pathological changes in the vessels themselves. In the current study, we analyzed the points to be considered during surgery for atherosclerotic cerebral aneurysms and the postoperative results.
MATERIALS AND METHODS
We retrospectively reviewed the medical records, radiological results, and surgical records, including intraoperative video recordings and photographs, of 262 patients who underwent cerebral aneurysm surgery. We then performed a detailed analysis of aneurysm features, surgical methods, and clinical outcomes.
RESULTS
Among 278 aneurysms in 262 patients, 73 aneurysms in 67 patients showed atherosclerotic features (atherosclerotic group, AG), and 205 aneurysms in 195 patients showed no evidence of atherosclerosis (non-atherosclerotic group, NAG). In the AG, clipping with multiple permanent clips was performed in 14 aneurysms, and clip slippage was found in four cases. Six AG cases had a remnant neck after clipping, which was significantly more frequent than in the NAG (p < 0.05). Clinical outcomes and surgery-related complications did not differ significantly between the two groups.
CONCLUSION
In the surgical repair of aneurysms, the incidence of ischemia, which is irreversible or severe, might be greater in atherosclerotic than in non-atherosclerotic aneurysms. In addition, multiple clips might be applied to atherosclerotic aneurysms for effective obliteration and an aneurysm neck might be left to avoid a region of atheroma.

Keyword

Intracranial aneurysm; atherosclerosis; surgical procedure

MeSH Terms

Aneurysm
Atherosclerosis
Humans
Incidence
Intracranial Aneurysm*
Ischemia
Medical Records
Neck
Plaque, Atherosclerotic
Retrospective Studies
Video Recording

Figure

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  Fig. 1 Operative view of an aneurysm with atherosclerotic wall. (A) Atherosclerotic change in the parent artery and aneurysmal neck. (B) Atherosclerotic change in the parent artery and aneurysmal wall.

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  Fig. 2 Postoperative head computed tomography (CT) scan of a patient who underwent surgical neck clipping for a right anterior choroidal artery aneurysm which showed atherosclerotic change in the parent artery and aneurysmal neck. He then developed neurologic deficits postoperatively. It shows a low-density lesion of the right internal carotid artery territory. Right cerebral swelling creates a mass effect, resulting in midline shifting and ipsilateral ventricle compression.

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  Fig. 3 Schematic illustrations of cerebral aneurysms. (A) Non-atherosclerotic aneurysm prior to neck clip placement (above) and with neck clip in place (below). (B) Parent artery narrowing due to atheroma, with and without neck clip in place. (C) and (D) Atherosclerotic change in the aneurysm neck leads to sliding of the clip and results in a remnant neck after clipping.

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