Current treatment options and prognostic factors for ruptured distal anterior cerebral artery aneurysms

Abstract

Background: Distal anterior cerebral artery (ACA) aneurysms are rare, representing 1–9% of all intracranial aneurysms. The best treatment strategy for these aneurysms continues to be debated. We clarified the clinical features and treatment outcomes of patients with ruptured distal ACA aneurysms according to the treatment options at our institute. Methods: Thirty-seven consecutive patients (26 women; mean age, 65.2 years) with ruptured distal ACA aneurysms who underwent surgical clipping or coil embolization between 2012 and 2018 were included in the study. Clinical presentations, radiographic findings, and outcomes were retrospectively reviewed and compared between patients who underwent either surgical clipping or coil embolization. Risk factors associated with poor outcomes (modified Rankin Scale 4–6) were analyzed using multiple regression analysis. Results: Nineteen patients (51.4%) had World Federation Neurological Surgeons (WFNS) Grade IV-V, 18 (48.7%) had frontal lobe hematomas, and 13 (35.1%) had multiple aneurysms. Surgical clipping and endovascular coiling were performed in 28 (75.7%) and nine (24.3%) patients, respectively. Aneurysms located at the A4-5 portions were mainly treated by surgical clipping (P = 0.04). There were no significant between-group differences in procedure-related morbidity and mortality; however, the complete occlusion rate was higher in the surgical group (P < 0.01). Overall, a favorable neurological outcome at discharge (mRS 0–3) was obtained in 23 patients (62.5%). Multiple regression analysis revealed that WFNS Grade IV-V and frontal lobe hematomas were risk factors for poor outcomes (mRS 4–6). Conclusion: Acceptable outcomes were obtained in 62.5% of cases, and there were no significant between-group differences in treatment results between clipping and coiling. A poor WFNS grade and intracerebral hematomas were risk factors for a poor prognosis.

Treatment and outcome analysis of patients with ruptured distal anterior cerebral artery aneurysms: a multicenter real-world study

“…In addition, Martin Lehecka et al ( 4 ) reported that advanced age and higher Hunt-Hess classification (III-V) were risk factors for poor prognosis in ruptured DACAA. Yushiro Take’s study of 37 surgically treated DACAA cases also indicated that WFNs grade (IV-V) and intracranial hematoma were risk factors for poor prognosis ( 20 ). In light of these findings, we conducted univariate and multivariate Cox regression analyses on 17 factors that could potentially affect the survival status of patients with ruptured DACAA at the 2-year mark after hospital discharge.…”

Coil embolization for ruptured distal anterior cerebral artery aneurysm at the supracallosal portion: Two case reports

“…[3][4][5]9] Previous studies have reported that ruptured DACA aneurysms are more frequently complicated with intracerebral hematomas than aneurysms in other portions, although the rates vary from 17% to 73%. [1,3,13] Saccular aneurysms located in the distal portion of the genu are more frequently associated with ACA anomalies, such as bihemispheric type ACA or accessory ACA, which are considered to be primarily caused by hemodynamic stress. [3,6,8,9] As cerebral aneurysms may occur in the same portion following head trauma, it is necessary to confirm any history of trauma.…”

“…In previous reports, almost all aneurysms in the supracallosal portion were treated with aneurysmal neck clipping. [ 1 , 13 ] Compared with aneurysms in the genu portion, clipping surgery has a shallower operative field and is less likely to cause disorientation. Pericallosal artery aneurysms also tend to be wide-neck aneurysms that involve cortical branches from the dome neck despite their relatively small size.…”

“…Clipping surgery is frequently performed for ruptured DACA aneurysms that occur in the supracallosal portion. [1,13] In this report, we describe two cases of ruptured cerebral aneurysms in the supracallosal portion successfully treated with coil embolization. revealed a subarachnoid hemorrhage (SAH) and hematoma in the interhemispheric fissure [Figure 1a].…”

“…Clipping surgery is frequently performed for ruptured DACA aneurysms that occur in the supracallosal portion. [ 1 , 13 ]…”