Ruptured Anterior Communicating Artery Aneurysm

2019 ◽  
pp. 39-46
Author(s):  
E. Sander Connolly ◽  
Sean D. Lavine ◽  
Grace K. Mandigo ◽  
Dorothea Altschul ◽  
Ahsan Satar ◽  
...  
Keyword(s):  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Medical Risk ◽  
Microsurgical Treatment ◽  
Ruptured Aneurysms ◽  
Anterior Communicating Artery Aneurysms ◽  
Complex Anatomy ◽  
Endovascular Approach ◽  
Therapeutic Considerations ◽  
Small Aneurysms

Abstract: Anterior communicating artery aneurysms are among the most commonly encountered ruptured aneurysms. Both endovascular and microsurgical treatment should be considered. Their complex anatomy makes microsurgical treatment challenging, a concern that is amplified in the setting of subarachnoid hemorrhage. Nonetheless, many will still require microsurgical treatment. Small aneurysms and those with a broad neck are particularly likely to need microsurgical treatment. Posteriorly projecting aneurysms or those that present in patients who have high medical risk for surgery should be favored for an endovascular approach. This chapter reviews the diagnostic and therapeutic considerations in the management of ruptured anterior communicating artery aneurysms, including the selection of surgical approach based on aneurysm anatomy.

Incidental Anterior Communicating Artery Aneurysm

2019 ◽  
pp. 25-38
Author(s):  
Kurt Yaeger ◽  
J. Mocco
Keyword(s):  
Collateral Circulation ◽  
Artery Aneurysm ◽  
Careful Analysis ◽  
Anterior Communicating Artery ◽  
Unruptured Aneurysms ◽  
Anterior Communicating Artery Aneurysm ◽  
Perforating Artery ◽  
Anterior Communicating Artery Aneurysms ◽  
Complex Anatomy ◽  
History Of

Abstract: Anterior communicating artery aneurysms are among the most commonly encountered aneurysms in neurosurgical practice. While many are treatable using modern endovascular techniques, because of their often complex anatomy, both ruptured and unruptured anterior communicating artery aneurysms often require microsurgical treatment. Pre-operative analysis of the collateral circulation, the aneurysm orientation, the aneurysm height, morphology, and the dome-to-neck ratio can all affect decision-making. For unruptured aneurysms, a careful analysis of the natural history of rupture risk versus the risks of surgery or endovascular treatment will determine if treatment is recommended and what modality. At surgery, perforating artery preservation is of utmost importance. This chapter discusses these issues as considered in the management of an incidental, unruptured anterior communicating artery aneurysm.

Balloon remodeling-assisted Woven EndoBridge technique: description and feasibility for complex bifurcation aneurysms

2018 ◽  
Vol 11 (4) ◽  
pp. 386-389 ◽  
Author(s):  
Cristian Mihalea ◽  
Simon Escalard ◽  
Jildaz Caroff ◽  
Léon Ikka ◽  
Aymeric Rouchaud ◽  
...  
Keyword(s):  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Neck Size ◽  
Complex Anatomy ◽  
Woven Endobridge ◽  
Web Device ◽  
Middle Cerebral Artery Aneurysms ◽  
Wide Neck

BackgroundWoven EndoBridge (WEB) deployment remains challenging in aneurysms with a complex shape or orientation.ObjectiveTo show that embolization of wide-neck bifurcation aneurysms using the WEB device balloon remodeling-assisted technique is a feasible and elegant endovascular solution compared with other techniques, such as balloon remodeling or stent-assisted coiling.Materials and methods10 cases (10 aneurysms in 9 patients) of balloon remodeling-assisted WEB treatment of unruptured complex bifurcation aneurysms were treated in our institution and retrospectively analyzed. Details of clinical presentations, technical details, perioperative and postoperative complications, and outcomes were collected. Immediate and long-term angiographic results were also evaluated.ResultsAneurysms included six middle cerebral artery aneurysms, one anterior communicating artery aneurysm, one posterior communicating artery aneurysm, one basilar artery aneurysm, and one T-shaped carotid aneurysm. Mean dome width was 6.55 mm, mean neck size 4.5 mm, mean height 4.79 mm, and mean dome-to-neck ratio was 1:1.46. Treatment was performed exclusively with the balloon remodeling-assisted WEB technique in all cases. The device was successfully deployed in every case. Periprocedural thromboembolic or hemorrhagic events did not occur. The modified Rankin Scale score at discharge was 0 for all patients. At mid-term or long-term angiographic follow-up, adequate occlusion was observed in 7 aneurysms from 8 controlled cases (87.5%), and one patient (2 aneurysms) did not have angiographic follow-up.ConclusionThe balloon remodeling-assisted WEB technique seems to be a safe and effective solution for endovascular treatment of unruptured wide-neck bifurcation aneurysms with specific complex anatomy. However, further studies are needed to evaluate the rate of complications and long-term efficacy.

Ruptured anterior communicating artery aneurysms treated by coiling technique: characteristics, outcomes and prognosises

2020 ◽  
Author(s):  
Tuan Minh Nguyen Tran
Keyword(s):  
Artery Aneurysm ◽  
Sudden Onset ◽  
Endovascular Coiling ◽  
Hospital Death ◽  
Anterior Communicating Artery ◽  
P Value ◽  
Anterior Communicating Artery Aneurysms ◽  
Complete Obliteration ◽  
Stroke Center ◽  
A Prospective Study

RUPTURED ANTERIOR COMMUNICATING ARTERY ANEURYSMS TREATED BY COILING TECHNIQUE: CHARACTERISTICS, OUTCOMES AND PROGNOSISES Abstract A prospective study of 31 patients with ruptured anterior communicating artery aneurysm (ACoA) treated by endovascular coiling was carried out at Stroke center - Hue Central Hospital, from September 2018 – February 2020. The results obtained were: Male:female ratio = 2.1: 1, age 54.2 ± 15.3 (21-85); clinically sudden onset 100%, headache 87.1%, vomiting 45.2%, cranial nerve palsy 12.9%, hemiparesis 29%, aphasia 11%; Hunt-Hess 1-3 61.3%, Fisher 1-3 35.2%, Glasgow coma score ≤8 19.4%; aneurysm size 5.6 ± 2.0 mm (2.5-10 mm), complete obliteration 81%; delayed ischemia 19.4%, ventricular dilation 45.2%, in-hospital recurrent hemorrhage 0%, modified Rankin scale (mRS) 0-2 at discharge 51.6%; mRS 0-2 after 3 months 54.8%, in-hospital death 0%, death within 3 months 22.6%. There was a moderate correlation between Hunt-Hess, Glasgow score at admission and mortality within 3 months; there was a statistically significant relationship between Glasgow coma scale-based groups and mortality (OR 0.34; 95% CI: 0.12 - 0.99; p = 0.047, p-value 77.4%).

scholarly journals Consecutive Endovascular Treatment of 20 Ruptured Very Small (<3 mm) Anterior Communicating Artery Aneurysms

2016 ◽  
Vol 5 (1-2) ◽  
pp. 57-64 ◽  
Author(s):  
Kaiz S. Asif ◽  
Ahsan Sattar ◽  
Marc A. Lazzaro ◽  
Brian-Fred Fitzsimmons ◽  
John R. Lynch ◽  
...  
Keyword(s):  
Coil Embolization ◽  
External Ventricular Drain ◽  
Maximum Diameter ◽  
Anterior Communicating Artery ◽  
Anterior Communicating Artery Aneurysms ◽  
Average Maximum ◽  
Aneurysm Occlusion ◽  
Small Aneurysms ◽  
Clinical Worsening

Background: Small aneurysms located at the anterior communicating artery carry significant procedural challenges due to a complex anatomy. Recent advances in endovascular technologies have expanded the use of coil embolization for small aneurysm treatment. However, limited reports describe their safety and efficacy profiles in very small anterior communicating artery aneurysms. Objective: We sought to review and report the immediate and long-term clinical as well as radiographic outcomes of consecutive patients with ruptured very small anterior communicating artery aneurysms treated with current endovascular coil embolization techniques. Methods: A prospectively maintained single-institution neuroendovascular database was accessed to identify consecutive cases of very small (<3 mm) ruptured anterior communicating artery aneurysms treated endovascularly between 2006 and 2013. Results: A total of 20 patients with ruptured very small (<3 mm) anterior communicating artery aneurysms were consecutively treated with coil embolization. The average maximum diameter was 2.66 ± 0.41 mm. Complete aneurysm occlusion was achieved for 17 (85%) aneurysms and near-complete aneurysm occlusion for 3 (15%) aneurysms. Intraoperative perforation was seen in 2 (10%) patients without any clinical worsening or need for an external ventricular drain. A thromboembolic event occurred in 1 (5 %) patient without clinical worsening or radiologic infarct. Median clinical follow-up was 12 (±14.1) months and median imaging follow-up was 12 (±18.4) months. Conclusion: This report describes the largest series of consecutive endovascular treatments of ruptured very small anterior communicating artery aneurysms. These findings suggest that coil embolization of very small aneurysms in this location can be performed with acceptable rates of complications and recanalization.

Orbitocraniobasal Approach for Anterior Communicating Artery Aneurysms

Neurosurgery ◽  
1986 ◽  
Vol 18 (3) ◽  
pp. 367-369 ◽  
Author(s):  
Kazuhiko Fujitsu ◽  
Takeo Kuwabara
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Surgical Treatment ◽  
Skull Base ◽  
Acute Stage ◽  
Anterior Communicating Artery ◽  
Ruptured Aneurysms ◽  
Anterior Communicating Artery Aneurysms ◽  
The Brain

Abstract We describe an orbitofrontotemporobasal craniotomy technique that allows excellent access to anterior communicating artery aneurysms. This orbitocraniobasal approach is particularly useful for the surgical treatment of ruptured aneurysms in the acute stage of subarachnoid hemorrhage, when retraction of the brain needs to be kept to a minimum. With this approach, retraction of the orbital contents decreases the amount of retraction of the brain to such an extent that a brain spatula is not necessary for access to the anterior communicating artery complex. The procedure is described, as is a modification of the approach for removal of large tumors on the skull base.

Treatment of an anterior communicating artery aneurysm through an anomalous anastomosis from the cavernous internal carotid artery

2002 ◽  
Vol 97 (6) ◽  
pp. 1432-1435 ◽  
Author(s):  
Virany Huynh Hillard ◽  
Kiran Musunuru ◽  
Chiedozie Nwagwu ◽  
Kaushik Das ◽  
Raj Murali ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Anterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Surgical Clipping ◽  
Content Type ◽  
Endovascular Approach

✓ Cavernous internal carotid artery (ICA)—anterior cerebral artery (ACA) anastomoses are unusual anomalies in which a duplicated A1 segment of the ACA arises from the infraoptic ICA. The authors report on a 30-year-old woman who presented with subarachnoid hemorrhage from an anterior communicating artery (ACoA) aneurysm associated with an extremely rare variant of this anastomosis. The extra A1 segment emerged from the ICA within the cavernous sinus rather than at or above the level of the ophthalmic artery. The presence of the anomalous vessel provided a straightforward endovascular approach to the ACoA and allowed the use of coil placement rather than surgical clipping to treat the aneurysm successfully.

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