J Korean Neurosurg Soc.  2015 Sep;58(3):197-204. 10.3340/jkns.2015.58.3.197.

Endovascular Treatment of Ruptured Pericallosal Artery Aneurysms

• Ko JK
• Kim HS
• Choi HJ
• Lee TH
• Yun EY
• Choi CH

• KMID: 2191360
• DOI: http://doi.org/10.3340/jkns.2015.58.3.197

Abstract

OBJECTIVE
Aneurysms arising from the pericallosal artery (PA) are uncommon and challenging to treat. The aim of this study was to report our experiences of the endovascular treatment of ruptured PA aneurysms.
METHODS
From September 2003 to December 2013, 30 ruptured PA aneurysms in 30 patients were treated at our institution via an endovascular approach. Procedural data, clinical and angiographic results were retrospectively reviewed.
RESULTS
Regarding immediate angiographic control, complete occlusion was achieved in 21 (70.0%) patients and near-complete occlusion in 9 (30.0%). Eight procedure-related complications occurred, including intraprocedural rupture and early rebleeding in three each, and thromboembolic event in two. At last follow-up, 18 patients were independent with a modified Rankin Scale (mRS) score of 0-2, and the other 12 were either dependent or had expired (mRS score, 3-6). Adjacent hematoma was found to be associated with an increased risk of poor clinical outcome. Seventeen of 23 surviving patients underwent follow-up conventional angiography (mean, 16.5 months). Results showed stable occlusion in 14 (82.4%), minor recanalization in two (11.8%), and major recanalization, which required recoiling, in one (5.9%).
CONCLUSION
Our experiences demonstrate that endovascular treatment for a ruptured PA aneurysms is both feasible and effective. However, periprocedural rebleedings were found to occur far more often (20.0%) than is generally suspected and to be associated with preoperative contrast retention. Analysis showed existing adjacent hematoma is predictive of a poor clinical outcome.

Keyword

Intracranial aneurysm; Pericallosal artery; Endovascular treatment

MeSH Terms

Aneurysm*
Angiography
Arteries*
Follow-Up Studies
Hematoma
Humans
Intracranial Aneurysm
Retrospective Studies
Rupture

Figure

• 

  Fig. 1 Images showing a ruptured aneurysm of the right pericallosal artery (PA). A : Unenhanced computed tomography (CT) in a 52-year-old female patient demonstrates diffuse subarachnoid hemorrhage and a scant intraparenchymal hematoma (arrow) at the right cingulate gyrus. B : Conventional angiograph showing a ruptured 9.9 mm PA aneurysm with multiple lobulations. C : Conventional angiogram showing contrast retention and delayed washout (arrow)-a characteristic angiographic feature of cerebral pseudoaneurysm. D and E : Unsubtracted and subtracted images acquired immediately after stent-assisted coiling demonstrating complete aneurysm occlusion. Coiling was uneventful without clinically and angiographically evident intraprocedural rupture. F : Unenhanced CT image obtained 2 hours after the procedure shows hematoma enlargement with worsening of the patient's condition, indicating early rebleeding.

• 

  Fig. 2 This 47-year-old female patient of Hunt and Hess grade II was admitted after rupture of a left pericallosal artery aneurysm. A : Unenhanced CT image obtained at admission demonstrated a subtle subarachnoid hemorrhage at the interhemispheric fissure. B : Conventional angiogram shows a ruptured 3.2 mm aneurysm at the pericallosal-frontopolar artery bifurcation. C : A sudden rise of arterial blood pressure occurred during insertion of the 1st coil, indicating rebleeding. Outpouching of part of the coil is seen outside the aneurismal cavity, and 30 mg of protamine sulfate promptly injected. D and E : Unsubtracted and subtracted images obtained immediately after additional coil insertion show extravasation of contrast medium, indicating rupture. F and G : Unsubtracted and subtracted postembolization angiogram (after placement of additional coils) reveals complete aneurysm occlusion and no more extravasation of contrast medium. H : Unenhanced CT image obtained immediately after the procedure showing extravasation of contrast medium and blood in the subarachnoid space and ventricle, indicating rebleeding.

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