Endovascular treatment of distal anterior cerebral artery aneurysms: Long-term results

OBJECTIVEA direct comparison of endovascular versus microsurgical treatment of ruptured middle cerebral artery (MCA) aneurysms in randomized trials is lacking. As endovascular treatment strategies continue to evolve, the number of reports of endovascular treatment of these lesions is increasing. Herein, the authors report a detailed post hoc analysis of ruptured MCA aneurysms treated by microsurgical clipping from the Barrow Ruptured Aneurysm Trial (BRAT).METHODSThe cases of patients enrolled in the BRAT who underwent microsurgical clipping for a ruptured MCA aneurysm were reviewed. Characteristics of patients and their clinical outcomes and long-term angiographic results were analyzed.RESULTSFifty patients underwent microsurgical clipping of a ruptured MCA aneurysm in the BRAT, including 21 who crossed over from the endovascular treatment arm. Four patients with nonsaccular (e.g., dissecting, fusiform, or blister) aneurysms were excluded, leaving 46 patients for analysis. Most (n = 32; 70%) patients presented with a Hunt and Hess grade II or III subarachnoid hemorrhage, with a high prevalence of intraparenchymal blood (n = 23; 50%), intraventricular blood (n = 21; 46%), or both. At the last follow-up (up to 6 years after treatment), clinical outcomes were good (modified Rankin Scale score 0–2) in 70% (n = 19) of 27 Hunt and Hess grades I–III patients and in 36% (n = 4) of 11 Hunt and Hess grade IV or V patients. There were no instances of rebleeding after the surgical clipping of aneurysms in this series at the time of last clinical follow-up.CONCLUSIONSMicrosurgical clipping of ruptured MCA aneurysms has several advantages over endovascular treatment, including durability over time. The authors report detailed outcome data of patients with ruptured MCA aneurysms who underwent microsurgical clipping as part of a prospective, randomized trial. These results should be used for comparison with future endovascular and surgical series to ensure that the best results are being achieved for patients with ruptured MCA aneurysms.

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Long-Term Excess Mortality in 280 Patients with Ruptured Distal Anterior Cerebral Artery Aneurysms

Neurosurgery ◽

10.1097/00006123-200602000-00042 ◽

2006 ◽

pp. 398

Author(s):

Martin Lehecka ◽

Mika Niemel?? ◽

Johanna Sepp??nen ◽

Hanna Lehto ◽

Ayse Karatas ◽

...

Keyword(s):

Cerebral Artery ◽

Excess Mortality ◽

Anterior Cerebral Artery ◽

Distal Anterior Cerebral Artery

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Endovascular treatment of ruptured distal anterior cerebral artery aneurysm

Neurology India ◽

10.4103/0028-3886.63809 ◽

2010 ◽

Vol 58 (2) ◽

pp. 259 ◽

Cited By ~ 8

Author(s):

Jianmin Liu ◽

Qinghai Huang ◽

Jie Shen ◽

Yi Xu

Keyword(s):

Endovascular Treatment ◽

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Artery Aneurysm ◽

Anterior Cerebral Artery Aneurysm ◽

Distal Anterior Cerebral Artery ◽

Cerebral Artery Aneurysm

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Endovascular Treatment of Distal Anterior Cerebral Artery Aneurysms: Single-Center Experience and a Systematic Review

American Journal of Neuroradiology ◽

10.3174/ajnr.a3629 ◽

2013 ◽

Vol 34 (12) ◽

pp. 2317-2320 ◽

Cited By ~ 15

Author(s):

C.L. Sturiale ◽

W. Brinjikji ◽

M.H. Murad ◽

H.J. Cloft ◽

D.F. Kallmes ◽

...

Keyword(s):

Systematic Review ◽

Endovascular Treatment ◽

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Single Center ◽

Single Center Experience ◽

Distal Anterior Cerebral Artery

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Long-Term Excess Mortality in 280 Patients with Ruptured Distal Anterior Cerebral Artery Aneurysms

Neurosurgery ◽

10.1227/01.neu.0000310181.20410.2b ◽

2006 ◽

Vol 58 (2) ◽

pp. 405

Author(s):

Martin Lehecka ◽

Mika Niemelä ◽

Johanna Seppänen ◽

Hanna Lehto ◽

Ayse Karatas ◽

...

Keyword(s):

Cerebral Artery ◽

Excess Mortality ◽

Anterior Cerebral Artery ◽

Distal Anterior Cerebral Artery

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Abstract TP428: Microsurgical and Endovascular Treatment of Ruptured Distal Anterior Cerebral Artery Aneurysms

Stroke ◽

10.1161/str.44.suppl_1.atp428 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Keun Young Park ◽

Yoon Ho Lee ◽

Eun Hyun Ihm ◽

Yong Cheol Lim ◽

Joonho Chung ◽

...

Keyword(s):

Endovascular Treatment ◽

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Ct Scanning ◽

Endovascular Coiling ◽

Surgical Morbidity ◽

Technical Success Rate ◽

Microsurgical Clipping ◽

Maximal Diameter ◽

Distal Anterior Cerebral Artery

Introduction: Distal anterior cerebral artery (DACA) aneurysms are less common and surgical morbidity has been reported relatively high due to intraoperative rupture and narrow surgical field. Endovascular treatment can be alternative to surgery. This study investigated the efficacy and safety of endovascular coiling for ruptured DACA aneurysms comparing with microsurgical clipping. Patients and Methods: Between January 1999 and March 2012, consecutive 94 patients with ruptured DACA aneurysm were treated by surgical clipping (n=52, 55.3%) and endovascular coiling (n=42, 44.7%) in five institutions including only 2 cases of recurrence (2.1%, 1 in clip and 1 in coil). The clinical outcomes of patients and procedure-related complications (intraprocedural rupture and any infarction) were evaluated and compared between two groups. Results: There were 38 males and 56 females (mean age; 55.1 years). Initial Hunt-Hess grade was GII in 25 patients (37.2%), GIII in 36 patients (38.3%), GIV in 12 patients (12.8%), and GV in 11 patients (11.7%), which was significantly higher in coil group (2.77 in clip vs 3.26 in coil, p=0.016). Initial CT scanning showed ruptured DACA aneurysm with ICH (n=35; 37.2%) and hydrocephalus (n=25; 26.6%). Maximal diameter of aneurysm was less than 5mm in 36 (38.3%), 5~10mm in 53 (56.4%), and 10mm and more than in 5 (5.3%). Technical success rate was 100% and complete occlusion or neck remnant of aneurysm was achieved in 87 [92.6%, 49 (96.1%) in clip vs 38 (90.5%) in coil, p=0.404] and incomplete in 6 (6.4%). At discharge, favorable outcome (modified GOS; good and fair) was obtained in 70 [77.8%, 44 (84.6%) in clip vs 26 (68.4%) in coil, p=0.078]. Intraprocedural rupture occurred only in clipping group [6 cases (11.5%), p=0.031]. Any procedure-related infarction occurred in 7 [7.4%, 6 (11.5%) in clip vs 1 (2.4%) in coil, p=0.126]. Intraprocedural thrombus was detected in 5 cases of coil group and most of them were restored by thrombolytic therapy. There was one case of acute rebleeding in coiling group and this patient died. Conclusions: Endovascular coiling was comparable treatment with clipping for ruptured DACA aneurysms.

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