J Cerebrovasc Endovasc Neurosurg.  2022 Dec;24(4):341-348. 10.7461/jcen.2022.E2022.06.001.

Treatment results of anterior choroidal artery aneurysms treated mostly with coil embolization: A single-center experience

• Roh HK
• Jeong EO
• Kim KH
• Jeong HW
• Lee HJ
• Choi SW
• Kim SH
• Koh HS
• Youm JY
• Kwon HJ

• KMID: 2537318
• DOI: http://doi.org/10.7461/jcen.2022.E2022.06.001

Abstract

Background
Anterior choroidal artery (AchA) aneurysms are usually small in diameter because of the size of the involved artery and are often wide-necked. Coil embolization of AchA aneurysm is thus challenging because of serious risks, such as thromboembolic occlusion of artery and perforation of aneurysm dome. Therefore, aneurysmal neck clipping remains widely performed despite a recent increase in the use of coil embolization for aneurysm treatment. We report the treatment results of AchA aneurysms mostly (92.3%) treated with coil embolization at our institute.
Methods
The database and medical records of patients who underwent coil embolization for AchA aneurysms were retrospectively analyzed. The clinical and imaging results and procedure-related complications were investigated after coil embolization performed between January 2006 and March 2022 at our institute.
Results
In total, 96 AchA aneurysms comprising 65 unruptured and 31 ruptured aneurysms, including only 1 ruptured aneurysm (1.0%) re-embolized at postoperative day 192 because of coil compaction, were evaluated. After the initial coil embolization, complete occlusion was attained in 41, residual neck in 45, and residual aneurysm in 10 patients. Follow-up radiological studies after 6–174 months were performed for 80 aneurysms. Complete occlusion was noted in 57 patients, residual neck in 22, and residual aneurysm in 1. The dysarthria experienced by one (1.0%) patient was the only symptomatic procedure-related complication. After coil embolization, neither delayed new rupture nor re-rupture was observed.
Conclusions
The results of this study demonstrate that coil embolization is a safe and effective treatment option for patients with AchA aneurysms.

Keyword

Anterior choroidal artery aneurysm; Cerebral aneurysm; Coil embolization; Outcome; Procedure-related complication

Figure

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  Fig. 1. Classification of AchA aneurysms according to the relations between ICA, AchA, and aneurysm. (A, B) Digital subtraction angiography and native angiographic images of aneurysm showing type A AchA aneurysm where AchA arises at the junction of the ICA and aneurysm. (C, D) These angiograms show type B AchA aneurysm. Type B indicates that AchA originates from the neck of the aneurysm. AchA, anterior choroidal artery; ICA, internal carotid artery

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  Fig. 2. Type A small aneurysm (1.4 mm×1.5 mm×1.4 mm) in a 62-year-old woman treated with coil embolization. (A) The angiogram demonstrates tiny aneurysm where AchA originates from the junction of the ICA and aneurysm. (B) Native angiographic image shows that the microcatheter tip (arrow) is positioned near the neck of the aneurysm after filling the aneurysm with one coil. (C) Post-embolization digital subtraction angiogram shows neck remnant of the aneurysm. AchA, anterior choroidal artery; ICA, internal carotid artery

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