J Korean Neurosurg Soc.  2015 Sep;58(3):184-191. 10.3340/jkns.2015.58.3.184.

Eleven Year's Single Center Experience of Endovascular Treatment of Anterior Communicating Artery Aneurysms: Focused on Digital Subtraction Angiography Follow-Up Results

• Hur CW
• Choi CH
• Cha SH
• Lee TH
• Jeong HW
• Lee JI

• KMID: 2191356
• DOI: http://doi.org/10.3340/jkns.2015.58.3.184

Abstract

OBJECTIVE
Anterior communicating artery (AcomA) aneurysms represent the most common intracranial aneurysms and challenging to treat due to complex vascularity. The purpose of this study was to report our experience of endovascular treatment of AcomA aneurysms.
METHODS
Between January 2003 and December 2013, we retrospectively reviewed the medical records of 134 AcomA aneurysm patients available more than 6 months conventional angiographic and clinical follow-up results. We focused on aneurismal or AcomA vascular characters, angiographic and clinical follow-up results, and retreatment.
RESULTS
The rate of ruptured cases was 75.4%, and the small (<10 mm) aneurysms were 96.3%. Based on the subtypes defined by dominance of A1, 79 patients (59%) had contralateral A1 hypoplasia or agenesis. The immediate post-procedural angiography confirmed complete occlusion in 75.4%, partial occlusion in 24.6%. Procedure related complications were observed in 25 (18.6%) patients. Most of the adverse events were asymptomatic. Follow-up conventional angiography at > or =6 months was performed in all patients (mean 16.3 months) and major recanalization was noted in 6.7% and regrowth in one case. The aneurysm size (p=0.016), and initial treatment results (p=0.00) were statistically significant risk factors related to aneurysm recurrence. An overall improvement in mRS was observed during the clinical follow-up period and no rebleeding episode occurred.
CONCLUSION
This study demonstrated that endovascular treatment is an effective treatment modality for AcomA aneurysms with low morbidity. Patients should take long term clinical and angiographic follow-up in order to assess the recurrence and warrant retreatment, especially ruptured, large, and initially incomplete occluded aneurysms.

Keyword

Endovascular treatment; Anterior communicating artery aneurysm; DSA follow up

MeSH Terms

Aneurysm
Angiography
Angiography, Digital Subtraction*
Arteries
Follow-Up Studies*
Humans
Intracranial Aneurysm*
Medical Records
Recurrence
Retreatment
Retrospective Studies
Risk Factors

Figure

• 

  Fig. 1 Images of anterior communicating artery aneurysms with contralateral A1 hypoplasia (A-D) and agenesis (E-H). A and B : Right and left internal carotid artery angiographies demonstrate left anterior communicating artery aneurysm with right A1 hypoplasia (black arrow). C : Final image after coiling shows complete occlusion of the aneurysm. D : The 6 months follow-up angiogram confirms stable occlusion of the coiled aneurysm. E and F : Both internal carotid arteries digital subtraction angiographies shows left anterior communicating artery aneurysm with contralateral A1 agenesis. G and H : Angiography immediately after coiling and 2 years follow-up image confirms complete and stable occlusion of the aneurysm sac.

• 

  Fig. 2 Retreatment of a 51-years-old female patient with recurred aneurysm. A : Initial unsubtracted image of conventional angiography shows complete occlusion of an aneurysm sac. B : Unsubtracted image of 1 year follow-up demonstrates enlarged and loosened coil mass. C : Subtracted image of previously coiled aneurysm reveals contrast filling of the aneurysm sac (black arrow, regrowth). D : Retreatment of recurred aneurysm using simple coiling technique. E : X-ray image of retreated coil mass. F : Final angiography after retreatment demonstrates complete occlusion of the recurred aneurysm.

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