Ruptured Fusiform Aneurysm of the Proximal Anterior Cerebral Artery (A1 Segment)  -Case Report-

Aoki, Yosuke; Nemoto, Minoru; Yokota, Kyosuke; Kano, Toshiyuki; Goto, Shouzou; Sugo, Nobuo

doi:10.2176/nmc.47.351

Cited by 16 publications

(11 citation statements)

References 24 publications

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“…Fusiform aneurysms present with a spindle-shaped appearance and are characterized by dilated and tortuous arteries associated with atherosclerosis2). These aneurysms develop from the parent artery, irrespective of any bifurcation, forming a broad base, and both the parent artery and the aneurysm exhibit marked atherosclerosis2).…”

Section: Discussionmentioning

confidence: 99%

“…These aneurysms develop from the parent artery, irrespective of any bifurcation, forming a broad base, and both the parent artery and the aneurysm exhibit marked atherosclerosis2).…”

Section: Discussionmentioning

confidence: 99%

“…Intracranial fusiform aneurysms account for about 1% of cerebral aneurysms, are caused by atherosclerosis, and usually develop in the basilar artery, internal carotid artery (ICA), or middle cerebral artery (MCA)2,10). The management of ruptured fusiform aneurysm remains controversial.…”

Section: Introductionmentioning

confidence: 99%

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Stent-Assisted Coil Trapping in a Manual Internal Carotid Artery Compression Test for the Treatment of a Fusiform Dissecting Aneurysm

Seung

Kim

Park

2012

J Korean Neurosurg Soc

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Internal carotid artery (ICA) trapping can be used for the treatment of giant intracranial aneurysms, blood blister-like aneurysms, and fusiform dissecting aneurysms. Fusiform dissecting aneurysms are challenging to treat surgically and endovascularly because of no definite neck and critical perforators. Surgical or endovascular trapping of the ICA with or without an extracranial-intracranial bypass has commonly been used as an effective method to treat these lesions, but balloon test occlusion (BTO) must be performed. Here, we report a case of a ruptured fusiform dissecting aneurysm of the distal ICA, which was successfully treated using an endovascular ICA trapping with a manual ICA compression test instead of BTO.

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Section: Discussionmentioning

confidence: 99%

“…These aneurysms develop from the parent artery, irrespective of any bifurcation, forming a broad base, and both the parent artery and the aneurysm exhibit marked atherosclerosis2).…”

Section: Discussionmentioning

confidence: 99%

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Stent-Assisted Coil Trapping in a Manual Internal Carotid Artery Compression Test for the Treatment of a Fusiform Dissecting Aneurysm

Seung

Kim

Park

2012

J Korean Neurosurg Soc

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“…10 When A1 perforators are occluded, typical symptoms due to infarcts in the anterior hypothalamic region include emotional changes, personality disorders, and intellectual deficits. 2,14,15 To limit the risk of perforator infarction, it may be safer to carefully look for the RAH and to limit the length of the coil occlusion to the segment of the parent vessel that faces the neck of the aneurysm. We may have missed some asymptomatic infarcts that would have appeared on MR imaging.…”

Section: Ischemia Related To A1 Occlusionmentioning

confidence: 99%

“…[1][2][3] Wide-neck aneurysms, not only those located at A1, can be challenging to treat selectively by using an endovascular approach, and recurrences are more frequent even if treatment is successful. 4 When the patient has adequate collateral vessel pathways (a patent AcomA with an A1 segment on both sides), occlusion of the A1 segment at the level of the aneurysm may be considered.…”

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confidence: 99%

Endovascular Parent Artery Occlusion for the Treatment of Wide-Neck A1 Segment Aneurysms: A Single-Center Experience

Tollard¹,

Niemtschik²,

Darsaut³

et al. 2010

AJNR Am J Neuroradiol

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SUMMARY:The goal of this study was to evaluate the feasibility and efficacy of A1 occlusion at the level of wide necked A1 aneurysms, where there are bilateral patent A1 segments and a patent AcomA. Between 2000 and 2010, 9 patients with wide necked A1 aneurysms were treated by coiling of the aneurysm along with parent vessel occlusion. All aneurysms had a wide neck (Ն4mm). None were treated in the acute phase of a subarachnoid hemorrhage. Three small infarcts were noted on routine post-treatment head CT, 1 of which was symptomatic (transient hemiparesthesia). On control angiogram at 6 months or more, 3 A1 recanalizations were found, 2 of which had a stable small neck recurrence. None of the aneurysms ruptured on follow-up. In this series, parent artery occlusion was effective in treating wide-necked aneurysms arising from the A1 segment in patients with adequate collateral supply.ABBREVIATIONS: A1 ϭ the first segment of the ACA up to the AcomA; A2 ϭ the second segment of the ACA from the AcomA to the genu of the corpus callosum; ACA ϭ anterior cerebral artery; AcomA ϭ anterior communicating artery; c ϭ coiling; Dist ϭ distal third of the A1; DSA ϭ digital subtraction angiography; EVT ϭ endovascular treatment; FU ϭ follow-up; L ϭ left; MD ϭ maximum diameter; Mid ϭ middle third of the A1; MRA ϭ MR angiography; N ϭ neck; OD ϭ oculi dexter (right eye); Prox ϭ proximal third of the A1; R ϭ right; RAH ϭ recurrent artery of Heubner; s ϭ surgery; SAH ϭ subarachnoid hemorrhage P roximal ACA (A1) aneurysms are rare, accounting for 0.8%-3.4% of intracranial aneurysms.1-3 Wide-neck aneurysms, not only those located at A1, can be challenging to treat selectively by using an endovascular approach, and recurrences are more frequent even if treatment is successful. 4 When the patient has adequate collateral vessel pathways (a patent AcomA with an A1 segment on both sides), occlusion of the A1 segment at the level of the aneurysm may be considered. Materials and MethodsWe studied all patients with ACA aneurysms included in our data base and treated by endovascular methods during a 10-year period (January 2000 to January 2010). From this list, all patients treated for an A1 aneurysm by using parent vessel occlusion were selected for a systematic medical record and imaging review.The decision to occlude the parent vessel was always an a priori decision and was made after demonstration of collateral supply of the ACA by the contralateral carotid artery, by using manual compression or balloon-test occlusion. The parent vessel occlusion was never the result of a periprocedural complication.Our strategy consisted of coiling the aneurysm tightly and letting the coils bulge through the neck. Parent vessel occlusion was completed with coils when necessary, with the intention of keeping the occlusion as short as possible. All the procedures were performed with the patient under heparin administration to reach 3 times the baseline of anticoagulation time.With time, our policy regarding antiplatelet therapy changed. We are now administerin...

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Fusiform aneurysms of anterior cerebral artery: center experience and systematic literature review

Conte,

Cagil,

Lanzino

et al. 2023

Neurosurg Rev

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Ruptured Fusiform Aneurysm of the Proximal Anterior Cerebral Artery (A1 Segment) -Case Report-

Cited by 16 publications

References 24 publications

Stent-Assisted Coil Trapping in a Manual Internal Carotid Artery Compression Test for the Treatment of a Fusiform Dissecting Aneurysm

Stent-Assisted Coil Trapping in a Manual Internal Carotid Artery Compression Test for the Treatment of a Fusiform Dissecting Aneurysm

Endovascular Parent Artery Occlusion for the Treatment of Wide-Neck A1 Segment Aneurysms: A Single-Center Experience

Fusiform aneurysms of anterior cerebral artery: center experience and systematic literature review

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