Endovascular treatment of distal anterior cerebral artery aneurysms: technical results and review of the literature

J Neuroimaging. 2010 Jan;20(1):70-3. doi: 10.1111/j.1552-6569.2008.00324.x.


Background: We sought to report our technical success and complications in treating distal anterior cerebral artery (ACA) aneurysms with coil embolization.

Methods: We retrospectively reviewed all patients undergoing coil embolization of distal ACA aneurysms from September 1999 to March 2008. Patients were assessed for subarachnoid hemorrhage, fundus size, and fundus-to-neck ratio (F/N) < 2 or >or= 2. Technical success for aneurysms was assessed according to established criteria immediately post-procedure and at 6-month angiographic follow-up. Post-procedural outcomes were measured using the modified Rankin Scale (mRS) at discharge. A mRS <or= 2 for ruptured aneurysms or no change from baseline for unruptured aneurysms was considered a good clinical outcome.

Results: Based on an intention-to-treat principle, we attempted embolization of 28 distal ACA aneurysms in 26 patients and were technically successful in 26 aneurysms (93%). Our mean age was 58 +/- 11 years. Thirteen presented with acute rupture. Average aneurysm size was 5.7 +/- 2.8 mm in our cohort with 20/28 (71%) having an F/N >or= 2. Seventeen aneurysms with an F/N >or= 2 and 5 with an F/N < 2 were completely obliterated or had minimal neck remnants at the end of the procedure (79%). Fourteen aneurysms underwent 6-month angiographic follow-up and were either completely obliterated or had a minimal residual neck remnant. Clinical outcomes were good in 12/13 unruptured patients (93%) at the time of discharge and in 6/13 ruptured patients (46%) with 90-day follow-up. Three patients had ischemic complications that were considered non-disabling, and 2 patients died from complications related to their initial subarachnoid hemorrhage. Two patients had an aborted procedure from failure to catheterize the aneurysm.

Conclusion: Endovascular treatment of distal ACA aneurysms can achieve good technical and clinical outcomes.

Publication types

  • Review

MeSH terms

  • Adult
  • Aged
  • Anterior Cerebral Artery / pathology
  • Cerebral Angiography
  • Cohort Studies
  • Embolization, Therapeutic / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Intracranial Aneurysm / pathology
  • Intracranial Aneurysm / therapy*
  • Male
  • Middle Aged
  • Registries
  • Retrospective Studies
  • Severity of Illness Index
  • Subarachnoid Hemorrhage / drug therapy
  • Subarachnoid Hemorrhage / pathology
  • Time Factors
  • Treatment Outcome