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.

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.

Ruptured Intracranial Aneurysms With Small Basal Outpouching

Neurosurgery ◽  
2012 ◽  
Vol 71 (5) ◽  
pp. 994-1002 ◽  
Author(s):  
Jaechan Park ◽  
Hyunjin Woo ◽  
Dong-Hun Kang ◽  
Yongsun Kim ◽  
Seung Kug Baik
Keyword(s):  
High Risk ◽  
Intracranial Aneurysms ◽  
Optimal Treatment ◽  
Ruptured Aneurysm ◽  
Endovascular Coiling ◽  
Anterior Communicating Artery ◽  
Surgical Clipping ◽  
Aneurysm Clip ◽  
Ruptured Aneurysms ◽  
Ruptured Intracranial Aneurysms

Abstract BACKGROUND: Recognizing an aneurysmal basal rupture using angiographic evaluation is crucial for optimal treatment. OBJECTIVE: To evaluate the incidence of a small basal outpouching (the most common angiographic configuration suggesting a basal rupture), the incidence of a ruptured basal outpouching, and the results of surgical and endovascular treatments. METHODS: The occurrence of small basal outpouchings was determined in the initial angiographic examinations of 471 patients with a ruptured aneurysm. Information was also obtained from patient charts, surgical and interventional reports, operative video records, and reviews of radiological investigations. RESULTS: A small basal outpouching was identified in 41 (8.7%) of the 471 ruptured aneurysms. In the surgical series (n = 286), a basal rupture was identified in 8 (30.8%) of the 26 cases of a basal outpouching and successfully treated by aneurysm clip placement. In the endovascular series (n = 185), intraprocedural aneurysm rebleeding developed in 5 of the 15 patients (33.3%) with a basal outpouching, which was most commonly observed with anterior communicating artery aneurysms. CONCLUSION: The current surgical series included a 9% incidence of ruptured intracranial aneurysms with a small basal outpouching, and a 31% incidence of these basal outpouchings being identified as the rupture point. The results also suggested that endovascular coiling of a basal outpouching carries a high risk of intraprocedural aneurysm rebleeding, whereas surgical clipping is safer and provides more protection against rebleeding of aneurysms with a basal rupture.

scholarly journals Characteristics of Unruptured Compared to Ruptured Intracranial Aneurysms: A Multicenter Case–Control Study

Neurosurgery ◽  
2017 ◽  
Vol 83 (1) ◽  
pp. 43-52 ◽  
Author(s):  
Isabel C Hostettler ◽  
Varinder S Alg ◽  
Nichole Shahi ◽  
Fatima Jichi ◽  
Stephen Bonner ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Anterior Communicating Artery ◽  
Imaging Data ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Multivariable Analyses ◽  
Different Characteristics

Abstract BACKGROUND Only a minority of intracranial aneurysms rupture to cause subarachnoid hemorrhage. OBJECTIVE To test the hypothesis that unruptured aneurysms have different characteristics and risk factor profiles compared to ruptured aneurysms. METHODS We recruited patients with unruptured aneurysms or aneurysmal subarachnoid hemorrhages at 22 UK hospitals between 2011 and 2014. Demographic, clinical, and imaging data were collected using standardized case report forms. We compared risk factors using multivariable logistic regression. RESULTS A total of 2334 patients (1729 with aneurysmal subarachnoid hemorrhage, 605 with unruptured aneurysms) were included (mean age 54.22 yr). In multivariable analyses, the following variables were independently associated with rupture status: black ethnicity (odds ratio [OR] 2.42; 95% confidence interval [CI] 1.29-4.56, compared to white) and aneurysm location (anterior cerebral artery/anterior communicating artery [OR 3.21; 95% CI 2.34-4.40], posterior communicating artery [OR 3.92; 95% CI 2.67-5.74], or posterior circulation [OR 3.12; 95% CI 2.08-4.70], compared to middle cerebral artery). The following variables were inversely associated with rupture status: antihypertensive medication (OR 0.65; 95% CI 0.49-0.84), hypercholesterolemia (0.64 OR; 95% CI 0.48-0.85), aspirin use (OR 0.28; 95% CI 0.20-0.40), internal carotid artery location (OR 0.53; 95% CI 0.38-0.75), and aneurysm size (per mm increase; OR 0.76; 95% CI 0.69-0.84). CONCLUSION We show substantial differences in patient and aneurysm characteristics between ruptured and unruptured aneurysms. These findings support the hypothesis that different pathological mechanisms are involved in the formation of ruptured aneurysms and incidentally detected unruptured aneurysms. The potential protective effect of aspirin might justify randomized prevention trials in patients with unruptured aneurysms.

scholarly journals Single center experience and technical nuances in the treatment of distal anterior cerebral artery aneurysms

2017 ◽  
Vol 31 (1) ◽  
pp. 17-24 ◽  
Author(s):  
Dorin Nicolae Gherasim ◽  
Gabriel Gyorki ◽  
Adrian Balasa
Keyword(s):  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Anterior Cerebral Artery ◽  
Complication Rates ◽  
Ruptured Aneurysms ◽  
Single Center Experience ◽  
Radiological Data ◽  
Treatment Morbidity ◽  
Distal Anterior Cerebral Artery ◽  
Lost To Follow Up

AbstractObjective: This study presents the experience of one neurosurgical center in the treatment of 18 consecutive patients with distal anterior cerebral artery (DACA) aneurysms during a 10 years period. Our aim was to compare treatment outcomes of these lesions with intracranial aneurysms in general, and to present technical nuances in surgical treatment.Methods: We analyzed the clinical and radiological data of 18 patients treated between 2005 and 2015. All patients were treated surgically using the microscope. No patients were lost to follow-up. We compared treatment and outcome of ruptured DACA aneurysms (n 18) with all consecutive ruptured aneurysms treated in our clinic during the same period (n 446).Results: DACA aneurysms accounted for 4% of all intracranial aneurysms. They were smaller (median, 5,5 versus 9 mm) We found only one case with associated aneurysms (5,5%). DACA aneurysms presented more often with intracerebral hematomas (39% versus 26%) than ruptured aneurysms in general. Their microsurgical treatment showed the same complication rates (treatment morbidity, 15%) as for other ruptured aneurysms in literature. Their mortality rate was lower (11% versus 24%).Conclusion: Despite their specific anatomic features, and particular surgical technique, with modern treatment methods, ruptured DACA aneurysms have the same favorable outcome and lower mortality as ruptured aneurysms in general.

Long-term outcome following anterior cerebral artery ligation for ruptured anterior communicating artery aneurysms

1991 ◽  
Vol 74 (1) ◽  
pp. 51-54 ◽  
Author(s):  
William Taylor ◽  
J. Douglas Miller ◽  
Nicholas V. Todd
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Artery Ligation ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Content Type ◽  
Ruptured Aneurysms

✓ The long-term prognosis (15 years) was determined for 17 patients who had undergone anterior cerebral artery (ACA) ligation as the sole treatment for an anterior communicating artery aneurysm. The number of early and late rebleeds was lower than expected from previously ruptured aneurysms. Late ischemia was not a major complication while late postoperative epilepsy occurred in 19% of survivors. In a review of previously published series, ACA ligation appears to have significantly reduced the rates of both early and late rebleeding. This study helps to define the late results of “conservative” operations for ruptured aneurysms.

Cross-Flow at Anterior Communicating Artery and Implication in Cerebral Aneurysm Formation

2009 ◽  
Author(s):  
Liang-Der Jou ◽  
Michel E. Mawad
Keyword(s):  
Cerebral Aneurysm ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Cross Flow ◽  
Lateral Flow ◽  
Anterior Communicating Artery ◽  
Ruptured Aneurysms ◽  
Aneurysm Formation ◽  
The Right

The anterior communication artery (ACOM) connects the right and left anterior cerebral artery and establishes contra-lateral flow, permiting perfusion of brain at both sides. While the artery itself is very short in length and small in size, 35% of ruptured aneurysms are found to form at the ACOM [1] and these aneurysms also rupture when they are small [2].

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.

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