Definitive Treatment With Microsurgical Clipping After Recurrence and Rerupture of Coiled Anterior Cerebral Artery Aneurysms

2020 ◽  
Vol 19 (4) ◽  
pp. 393-402
Author(s):  
Daniel M S Raper ◽  
Caleb Rutledge ◽  
Ethan A Winkler ◽  
Adib A Abla
Keyword(s):  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Anterior Cerebral Artery ◽  
Significant Risk ◽  
Subsequent Treatment ◽  
Definitive Treatment ◽  
Endovascular Coiling ◽  
Anterior Communicating Artery ◽  
Recent Experience ◽  
Microsurgical Clipping

Abstract BACKGROUND The extent of obliteration of ruptured intracranial aneurysms treated with coil embolization has been correlated with the risk of rerupture. However, many practitioners consider that a small neck remnant is unlikely to result in significant risk after coiling. OBJECTIVE To report our recent experience with ruptured anterior cerebral artery aneurysms treated with endovascular coiling, which recurred or reruptured, requiring microsurgical clipping for subsequent treatment. METHODS Retrospective review of patients with intracranial aneurysms treated at our institution since August 2018. Patient and aneurysm characteristics, initial and subsequent treatment approaches, and outcomes were reviewed. RESULTS Six patients were included. Out of those 6 patients, 5 patients had anterior communicating artery aneurysms, and 1 patient had a pericallosal aneurysm. All initially presented with subarachnoid hemorrhage (SAH) and were treated with coiling. Recurrence occurred at a median of 7.5 mo. In 2 cases, retreatment was initially performed with repeat endovascular coiling, but further recurrence was observed. Rerupture from the residual or recurrent aneurysm occurred in 3 cases. In 2 cases, the aneurysm dome recurred; in 1 case, rerupture occurred from the neck. All 6 patients underwent treatment with microsurgical clipping. Follow-up catheter angiography demonstrated a complete occlusion of the aneurysm in all cases with the preservation of the parent vessel. CONCLUSION Anterior cerebral artery aneurysms may recur after endovascular treatment, and even small neck remnants present a risk of rerupture after an initial SAH. Complete treatment requires a complete exclusion of the aneurysm from the circulation. Even in cases that have been previously coiled, microsurgical clipping can represent a safe and effective treatment option.

scholarly journals Balloon-Assisted Cannulation for Difficult Anterior Cerebral Artery Access

2017 ◽  
Vol 7 (1-2) ◽  
pp. 48-52
Author(s):  
Varun Naragum ◽  
Mohamad AbdalKader ◽  
Thanh N. Nguyen ◽  
Alexander Norbash
Keyword(s):  
Cerebral Artery ◽  
Paradigm Shift ◽  
Intracranial Aneurysms ◽  
Anterior Cerebral Artery ◽  
Endovascular Coiling ◽  
Anterior Communicating Artery ◽  
Surgical Clipping ◽  
Ruptured Aneurysms ◽  
Common Location ◽  
Proximal Middle Cerebral Artery

The anterior communicating artery is a common location for intracranial aneurysms. Compared to surgical clipping, endovascular coiling has been shown to improve outcomes for patients with ruptured aneurysms and we have seen a paradigm shift favoring this technique for treating aneurysms. Access to the anterior cerebral artery can be challenging, especially in patients with tortuous anatomy or subarachnoid hemorrhage or in patients presenting with vasospasm. We present a technique for cannulating the anterior cerebral artery using a balloon inflated in the proximal middle cerebral artery as a rebound surface.

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

Stroke ◽  
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.

Endovascular flow diversion for treatment of anterior communicating artery region cerebral aneurysms: a single-center cohort of 50 cases

2017 ◽  
Vol 9 (7) ◽  
pp. 679-685 ◽  
Author(s):  
Geoffrey P Colby ◽  
Matthew T Bender ◽  
Li-Mei Lin ◽  
Narlin Beaty ◽  
Judy Huang ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Good Alternative ◽  
Flow Diversion ◽  
Definitive Treatment ◽  
Endovascular Coiling ◽  
Anterior Communicating Artery ◽  
Microsurgical Clipping ◽  
Alternative Treatment Option ◽  
Procedural Success

BackgroundFlow diversion represents a novel but definitive treatment for recurrent and difficult-to-coil aneurysms of the anterior communicating artery (ACoA) region, of which reports are limited.ObjectiveTo determine the effectiveness of the Pipeline embolization device (PED) in treating aneurysms in the ACoA region.MethodsWe retrospectively reviewed an IRB-approved database of patients with an aneurysm at a single institution for patients with ACoA or A1–A2 aneurysms treated with PED. Data analyzed included demographics, aneurysm characteristics, procedural details, follow-up results, and outcomes.ResultsA total of 50 procedures were performed on 41 patients, including seven patients who underwent bilateral ‘H-pipe’ PED placement. The average age was 56 years and 46% of the patients were female. The average aneurysm size was 4.5 mm, and two large (>10 mm) aneurysms were treated. The vessel of origin was either the ACoA (26 aneurysms, 63%) or the A1–A2 junction (15 aneurysms, 37%). Eighteen patients (44%) had prior subarachnoid hemorrhage and 20 had previously been treated either with clipping (6 aneurysms, 15%) or coiling (14 aneurysms, 34%). Procedural success was achieved in 48/50 cases (96%) and two cases were aborted. Coils were deployed adjunctively in two cases (4%). Procedural outcomes included no deaths, one major ischemic stroke (2%), and two patients with intracranial hemorrhage (4%). Complete aneurysm occlusion was achieved in 81% of patients at 6 months and 85% of patients at last follow-up digital subtraction angiography.ConclusionsThe PED can be used safely and effectively in the treatment of aneurysms of the ACoA region. This represents a good alternative treatment option to microsurgical clipping and endovascular coiling.

Occlusion of an “accessory” distal anterior cerebral artery during treatment of anterior communicating artery aneurysms

1991 ◽  
Vol 74 (1) ◽  
pp. 133-135 ◽  
Author(s):  
Kevin Gibbons ◽  
Leo N. Hopkins ◽  
Roberto C. Heros
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Anterior Communicating Artery ◽  
Case Histories ◽  
Content Type ◽  
Anterior Communicating Artery Aneurysms ◽  
Artery Segment ◽  
Distal Anterior Cerebral Artery ◽  
Clip Occlusion ◽  
Fine Print

✓ Two cases are presented in which clip occlusion of a third distal anterior cerebral artery segment occurred during treatment of anterior communicating artery aneurysms. Case histories, angiograms, operative descriptions, and postmortem findings are presented. The incidence of this anomalous vessel is reviewed. Preoperative and intraoperative vigilance in determining the presence of this anomaly prior to clip placement is emphasized.

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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