Prospective Factors of Temporary Arterial Occlusion During Anterior Communicating Artery Aneurysm Repair

2014 ◽  
pp. 231-235 ◽  
Author(s):  
Antônio Santos de Araújo Júnior ◽  
Paulo Henrique Pires de Aguiar ◽  
Mirella Martins Fazzito ◽  
Renata Simm ◽  
Marco Antonio Stefani ◽  
...  
Keyword(s):  
Arterial Occlusion ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Anterior Communicating Artery Aneurysm ◽  
Aneurysm Repair

scholarly journals Use of temporary arterial occlusion during anterior cerebral artery aneurysm repair

2018 ◽  
Vol 23 (4) ◽  
pp. 275-280
Author(s):  
Antônio Santos De Araújo Júnior ◽  
Paulo Henrique Pires De Aguiar ◽  
Mirella Martins Fazzito ◽  
Renata Simm ◽  
Apio Claudio Martins Antunes ◽  
...  
Keyword(s):  
Cox Regression ◽  
Arterial Occlusion ◽  
Artery Aneurysm ◽  
Statistical Correlation ◽  
Unfavorable Outcome ◽  
Anterior Communicating Artery ◽  
Fisher Grade ◽  
Temporary Occlusion ◽  
Aneurysm Repair ◽  
Temporary Clipping

Introduction: This study was undertaken to determine variables that could predict, in the perioperative period of anterior communicating artery (ACom) aneurysms surgeries, the likelihood of postoperative sequelae and complications, after temporary arterial occlusion. Patients and Methods: In a universe of 92 patients submitted to ACom aneurysm clipping between 2000 and 2013, 32 were operated in the last seven years. Among these patients, 21 needed temporary arterial occlusion during surgical aneurysm repair, and had their data examined retrospectively. Results: Aneurysms larger than 7mm were more likely to be treated with longer temporary clipping time than small aneurysms, <7mm (22±5.7 vs 11.3±4.1, t-Test, p <0.0001). There was no statistical correlation between time of occlusion and outcome (r=0.92, Pearson, p>0.08). Age, Glasgow Coma Scale (GCS) at initial evaluation, and Fisher scale at 1st CT scanning were independent factors of unfavorable outcome (Glasgow Outcome Scale ≤ 3) (cox-regression, p<0.001). Among variable factors, patients older than 50 years, an initial GCS under 13, and a Fisher grade III or IV resulted in worse outcome. Meanwhile gender, tobacco or alcohol addiction, obesity, arterial hypertension, dyslipidemia, location of temporary occlusion (A1 or A2), intraoperative rupture and the aneurysm size were not identified as independent prognostic factors. During follow-up period, two thirds of the patients had a favorable outcome (GOS ≥ 4), accomplishing normal daily life activities without major complications. Fifty-two percent of patients evolved with hydrocephalus, despite of routine fenestration of the lamina terminalis, performed in 71.4% of procedures. Most patients also developed clinical vasospasm (66.6%), with 19% of the patients presenting with a severe disease. Delayed ischemic neurological deficit was observed in 28.5%, secondary to severe vasospasm, and without any statistical correlation to time of temporary occlusion or intraoperative aneurysm rupture. Conclusion: Temporary clipping during ACom aneurysm repair does not seem to add more morbidities to the procedure, and is not an independent prognostic factor. However, age, initial GCS and Fisher grade are associated to unfavorable outcome.

scholarly journals Coaxial Access for Microcatheter Stabilization During Aneurysm Coiling: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Miri Kim ◽  
Rachyl Shanker ◽  
Anthony Kam ◽  
Matthew Reynolds ◽  
Joseph C Serrone
Keyword(s):  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Distal Catheter ◽  
Anterior Communicating Artery Aneurysm ◽  
Class 1 ◽  
Previously Treated ◽  
Aneurysm Occlusion ◽  
Intracranial Circulation ◽  
Aneurysm Coiling

Abstract Coaxial support is a fundamental technique utilized by neurointerventionalists to optimize distal catheter control within the intracranial circulation. Here we present a 41-yr-old woman with a previously coiled ruptured anterior communicating artery aneurysm with progressive recurrence harboring tortuous internal carotid anatomy to demonstrate the utility of coaxial support. Raymond-Roy classification of initial aneurysm coiling of class 1 resulted as class 3b over the 21 mo from initial treatment.1 The patient consented to stent-assisted coiling for retreatment of this aneurysm. Coaxial support was advanced as distally as possible in the proximal vasculature to improve catheter control, reducing dead space within which the microcatheter could move, decreasing angulations within proximal vasculature, limiting the movement of the native vessels, and providing a surface of lower friction than the endothelium. As the risk of recurrent subarachnoid hemorrhage in previously treated coiled aneurysms approaches 3%, retreatment occurs in 16.4% within 6 yr2 and in 17.4% of patients within 10 yr.3 Rerupture is slightly higher in patients who underwent coiling vs clipping, with the rerupture risk inversely proportional to the degree of aneurysm occlusion,4 further substantiating that coaxial support provides technical advantage in selected patients where additional microcatheter control is necessary for optimal occlusion. Pitfalls of this technique include vasospasm and vascular injury, which can be ameliorated by pretreatment of the circulation with vasodilators to prevent catheter-induced vasospasm. This case and model demonstration illustrates the technique of coaxial access in the stent-assisted coiling of a recurrent anterior communicating artery aneurysm and identification and management of catheter-induced vasospasm.

scholarly journals Totally thrombosed giant anterior communicating artery aneurysm

2015 ◽  
Vol 6 (02) ◽  
pp. 245-247
Author(s):  
V. R. Roopesh Kumar ◽  
Venkatesh S. Madhugiri ◽  
Gopalakrishnan M. Sasidharan ◽  
Sudheer Kumar Gundamaneni ◽  
Awdhesh Kumar Yadav ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Preoperative Diagnosis ◽  
Relevant Literature ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Gait Ataxia ◽  
Visual Dysfunction ◽  
Anterior Communicating Artery Aneurysm

ABSTRACTGiant anterior communicating artery aneurysmsarerare. Apatient presented with visual dysfunction, gait ataxia and urinary incontinence. MRI showed a giant suprasellar mass.At surgery, the lesion was identified as being an aneurysm arising from the anterior communicating artery.The difficulty in preoperative diagnosis and relevant literature are reviewed.

scholarly journals Vascular Geometry Associated with Anterior Communicating Artery Aneurysm Formation

2020 ◽  
Author(s):  
Jian Zhang ◽  
Anil Can ◽  
Pui Man Rosalind Lai ◽  
Srinivasan Mukundan ◽  
Victor M. Castro ◽  
...  
Keyword(s):  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Anterior Communicating Artery Aneurysm ◽  
Aneurysm Formation ◽  
Vascular Geometry

scholarly journals Patient Outcomes and Cerebral Infarction after Ruptured Anterior Communicating Artery Aneurysm Treatment

2017 ◽  
Vol 38 (11) ◽  
pp. 2119-2125 ◽  
Author(s):  
J.J. Heit ◽  
R.L. Ball ◽  
N.A. Telischak ◽  
H.M. Do ◽  
R.L. Dodd ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Patient Outcomes ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Anterior Communicating Artery Aneurysm ◽  
Aneurysm Treatment

Analysis of Anterior Cerebral Artery Tortuosity: Association with Anterior Communicating Artery Aneurysm Rupture

2019 ◽  
Vol 122 ◽  
pp. e480-e486 ◽  
Author(s):  
Roger M. Krzyżewski ◽  
Kornelia M. Kliś ◽  
Borys M. Kwinta ◽  
Małgorzata Gackowska ◽  
Krzysztof Stachura ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Aneurysm Rupture ◽  
Anterior Communicating Artery ◽  
Anterior Communicating Artery Aneurysm
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