Endovascular Coiling as the First Treatment Strategy for Ruptured Pericallosal Artery Aneurysms: Results, Complications, and Follow Up

Yamazaki, Takahisa; Sonobe, Makoto; Kato, Noriyuki; Kasuya, Hiromichi; Ikeda, Go; Nakamura, Kazuhiro; Ito, Yoshiro; Tsuruta, Wataro; Nakai, Yasunobu; Matsumura, Akira

doi:10.2176/nmc.53.409

Cited by 13 publications

(10 citation statements)

References 29 publications

(33 reference statements)

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“…The previous studies have shown that the Hunt and Hess grade at admission, intracerebral hemorrhage, intraventricular hemorrhage, severe preoperative hydrocephalus, age, and rebleeding before treatment were significant predictors of poor clinical outcomes in patients undergoing either endovascular or microsurgical treatment of distal ACA aneurysms. [ 1 , 16 , 24 ] In univariate analysis, age and hydrocephalus showed significant differences; however, no significant differences were found in multivariate analysis. This may be due to the small number of cases.…”

Section: Discussionmentioning

confidence: 87%

“…[ 7 ] Since then, several authors have reported high technical success rates, high complete occlusion rates, and good neurological outcomes. [ 4 , 7 , 15 , 16 , 22 , 24 ] Conversely, Pierot et al . described endovascular management of eight cases of distal ACA aneurysms in 1996; coil embolization was successful in only 25% cases.…”

Section: Discussionmentioning

confidence: 99%

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

Take

Kamide

Kikkawa

et al. 2021

Surgical Neurology International

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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.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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

Take

Kamide

Kikkawa

et al. 2021

Surgical Neurology International

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“…As a result, endovascular coiling provides a high rate of CO-similar to that achieved with surgical clipping-with improved outcomes gradually Table 4 Characteristics, outcome, and mortality/morbidity rates from six endovascular series and our DAC aneurysm cases Unless otherwise stated, the results are given as the number (%). CO: complete obliteration; DAC: distal access catheter; N/A: not available; RN: residual neck increasing 2, [14][15][16][17][18] (Table 4). Comparing five surgical clipping studies 2,7-10) ( Table 3) with seven endovascular coiling studies including our experiments 2, [14][15][16][17][18] (Table 4), the ratio of ruptured aneurysm and HH grade 4-5 are almost equal, although the total number of surgical clipping patients is 1.5 times that of endovascular coiling.…”

Section: Discussionmentioning

confidence: 99%

“…CO: complete obliteration; DAC: distal access catheter; N/A: not available; RN: residual neck increasing 2, [14][15][16][17][18] (Table 4). Comparing five surgical clipping studies 2,7-10) ( Table 3) with seven endovascular coiling studies including our experiments 2, [14][15][16][17][18] (Table 4), the ratio of ruptured aneurysm and HH grade 4-5 are almost equal, although the total number of surgical clipping patients is 1.5 times that of endovascular coiling. Our outcomes showed a slightly lower rate of CO/RN, although there were few complications and little re-bleeding.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Therapy of Distal Anterior Cerebral Artery Aneurysms: Single-institution Clinical Experience with 47 Patients (49 Aneurysms)

Suzuki

Yatomi

Yamamoto

et al. 2019

JNET

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Distal anterior cerebral artery (DACA) aneurysms are rare, accounting for 1-9% of all intracranial aneurysms. These aneurysms, however, are challenging to treat using surgical clipping and endovascular coiling. Nevertheless, according to recent reports, advances in endovascular therapy devices and technologies have produced better results. We therefore aimed to assess the current status of endovascular treatment of DACA aneurysms. Methods: Between 2004 and 2017, we treated 47 consecutive patients with 49 DACA aneurysms using endovascular coiling at Juntendo University Hospital and entered them into a database. In this retrospective study, we reviewed the patients' clinical presentation, radiographic findings, endovascular management, and outcomes. The results were then compared with those in the previous literature for DACA aneurysms that were treated by surgical clipping. Results: Among the 49 aneurysms, 15 (30.6%) presented with subarachnoid hemorrhage (SAH). Nine cases were lost to follow-up. Among the 15 aneurysms with SAH, 13 became Hunt and Hess grades I-III and 2 were grade IV. Intracerebral or intraventricular hematoma occurred in five patients with ruptured aneurysms. The mean aneurysm dome measured 4.6 mm (range 1.8-10.5 mm), and the mean aneurysm neck was 2.5 mm (range 0.7-5.6 mm). Altogether, 22 of the 49 aneurysms (44.9%) arose from the origin of the callosomarginal artery. After the initial procedure, complete occlusion (CO) and residual neck (RN) were achieved in 63.3% of the cases. Periprocedural complications were minimal, including one intraoperative rupture and two cases in which thromboembolization was happened, although one case of hemorrhage was asymptomatic. There was one death, and five aneurysms required reoperation. Conclusion: Endovascular coiling to treat DACA aneurysms is useful and can replace surgical clipping. However, the coil's recanalization rate was higher with the endovascular coil treatment than with surgical clipping, and long-term follow-up is often necessary.

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“…Based on these reports and the fact that previous reports included unruptured cases, whereas we did not, we believe that our intraprocedural rupture rate is not excessive. It is well known PA aneurysms are smaller than non-PA aneurysms tend and that they tend to rupture at a smaller size 10 13 27) . In a study of a large number of aneurysm cases, the average diameter of ruptured aneurysms was reported to be 8.2 mm 8) , whereas the average aneurysm diameter in our patients was 5.0 mm.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Ruptured Pericallosal Artery Aneurysms

Kim

Choi

et al. 2015

J Korean Neurosurg Soc

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ObjectiveAneurysms 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.MethodsFrom 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.ResultsRegarding 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%).ConclusionOur 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.

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Endovascular Coiling as the First Treatment Strategy for Ruptured Pericallosal Artery Aneurysms: Results, Complications, and Follow Up

Cited by 13 publications

References 29 publications

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

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

Endovascular Therapy of Distal Anterior Cerebral Artery Aneurysms: Single-institution Clinical Experience with 47 Patients (49 Aneurysms)

Endovascular Treatment of Ruptured Pericallosal Artery Aneurysms

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