J Korean Neurosurg Soc.  2022 Jan;65(1):40-48. 10.3340/jkns.2021.0191.

Long-Term Outcomes of Placement of a Single Transverse Stent through the Anterior Communicating Artery via the Nondominant A1 in Coil Embolization of Wide-Necked Anterior Communicating Artery Aneurysms

Affiliations
  • 1Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
  • 2Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea

Abstract


Objective
: Placement of a single transverse stent via the nondominant A1 across the anterior communicating artery (AComA) into the contralateral A2 can provide sufficient neck coverage for wide-necked bifurcation AComA aneurysms. The authors described the feasibility, safety and long-term outcomes of this technique.
Methods
: Between January 2015 and February 2018, placement of a single transverse stent via the nondominant A1 was attempted in 17 wide-necked bifurcation AComA aneurysms. The authors reviewed the medical records and radiological studies.
Results
: The technical success rate was 94.1% (16/17). Periprocedural thromboembolic complications occurred in one patient (6.3%) without permanent neurological deficits. The mean clinical follow-up duration was 39.9±9.8 months. No deaths or delayed thromboembolic complications occurred. The mean angiographic follow-up duration was 38.9±9.8 months. The immediate and final follow-up complete occlusion rates were 87.4 and 93.7%, respectively. There was no recanalization during the follow-up period.
Conclusion
: Placement of a single transverse stent via the nondominant A1 across the AComA into the contralateral A2 is a feasible and relatively safe endovascular technique for the treatment of wide-necked bifurcation AComA aneurysms, with good long-term occlusion rates and a reasonable complication rate, if only the nondominant A1 is applicable.

Keyword

Endovascular procedure; Anterior communicating artery aneurysm; Stents; Anterior cerebral artery

Figure

  • Fig. 1. Illustration of single transverse stenting via the nondominant A1 in coil embolization of an AComA aneurysm. A : The A2 segment on the dominant A1 side (arrow) is catheterized for stent delivery via the nondominant A1 (arrowhead) and AComA. Another microcatheter for coil delivery is located in the aneurysm through the dominant A1. B : A low-profile stent is deployed in order to fully cover the aneurysm neck. C : Coil embolization is performed under the protection of a deployed stent. AComA : anterior communicating artery.

  • Fig. 2. A wide-necked AComA aneurysm treated with single transverse stenting technique. A : DSA image showed a wide-necked bifurcation AComA aneurysm (arrow). B : After a microcatheter for coil delivery was navigated into the AComA aneurysm (dotted-line), right internal carotid artery angiography showed the nondominant A1 and AComA aneurysm in hazy form. C : A low-profile stent (LVIS Jr stent, 2.5×13 mm; MicroVention, Tustin, CA, USA) was inserted through a microcatheter that was navigated in the A2 on the dominant A1 side (arrowheads). D : The stent was deployed to fully cover the aneurysm neck. E : Bare platinum coils were packed until complete occlusion was achieved or further coiling was deemed unsafe. F : Immediate postembolization DSA showed that the aneurysm was completely occluded. DSA : digital subtraction angiography, AComA : anterior communicating artery.

  • Fig. 3. . A case of periprocedural thromboembolic complication. A : After stent deployment, right internal carotid artery angiography showed patency of nondominant A1 and ipsilateral A2 blood flow (arrows). B : Packing of bare platinum coils into the aneurysm. C : Immediate post-DSA showed that the aneurysm was completely occluded without complications. D : On the 6-hour follow-up diffusion-weighted image, there were multiple scattered infarctions in the left ACA-MCA border zone area (arrowheads). E : On the 6-hour follow-up DSA, there was no definite thrombus formation around the stented vessels. F : Occlusion of the left small ACA cortical branches was detected (arrows). DSA : digital subtraction angiography, ACA : anterior cerebral artery, MCA : middle cerebral artery.


Cited by  1 articles

Physiologic Flow Diversion Coiling Technique for Wide-Necked Aneurysms with an Asymmetric Bidirectional Flow at the Aneurysm Neck
Boseong Kwon, Yunsun Song, Yun Hyeok Choi, Dae Chul Suh
Neurointervention. 2022;17(3):133-142.    doi: 10.5469/neuroint.2022.00311.


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