Endovascular Treatment of Ruptured Pericallosal Artery Aneurysms

Abstract

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.

Factors Affecting the Outcome after Surgical Clipping of Ruptured Distal Anterior Cerebral Artery (DACA) Aneurysms

“…2,9 There are many known factors which affect the outcome of DACA aneurysms after surgical intervention, but there is sparsity of publication on these issues. 1,2,4,9,16,25 High H&H and MF grades, ICH, IVH, hydrocephalus, IOR, timing of surgery, and advanced age have been attributed for poor outcome after intervention. 1,9,10,25 Furtado et al found poor clinical grade on admission and initial ICH as a risk factor for poor prognosis.…”

“… 1 4 7 14 These days endovascular technique, which has been flourishing day by day, is equally effective for the treatment of ruptured DACA aneurysm. 12 13 14 16 17 18 22 Truly speaking, DACA aneurysms are difficult to treat either by surgery or endovascular procedures due to their fragility, small-sized dome, wide neck, broad-based origin, and peripheral location. Many recent studies have shown similar results of both procedures.…”

“… 2 9 10 11 However, treatment paradigm has been gradually shifting to endovascular procedure due to its rapid technological advancement and skill development. 6 12 13 14 15 16 17 18 Whatever treatment we choose for ruptured DACA aneurysms, outcome after intervention is less favorable than outcome of other anterior circulation aneurysms. 1 7 11 The aim of this study is to analyze the data and to determine factors which may influence outcome after surgical clipping of ruptured DACA aneurysms.…”

Therapy Results of Pericallosal Aneurysms: A Retrospective Unicenter Study

“… 7 A summary of nine studies on endovascular treated ruptured PAAs reported a favorable outcome (mRS ≤ 2) in 164/219 (74.9%, range 53% - 100%) cases. 11 …”