Technical strategy in endovascular treatment of proximal anterior cerebral artery aneurysms

Chang, Hyuk Won; Youn, Sung Won; Jung, Cheolkyu; Kang, Hyun-Seung; Sohn, Chul Ho; Kwon, Bum Sun; Han, Moon Hee

doi:10.1007/s00701-010-0804-5

Cited by 28 publications

(12 citation statements)

References 11 publications

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“…During endovascular embolization of A1-segment aneurysms, its often sessile nature with a relative wide neck poses the danger of the coils slipping into the parent vessel, an incomplete embolization and an intra-procedural rupture due to fragility of its wall. [7,8] The final point relates to A1-segment aneurysms being associated with a much higher incidence of multiple aneurysms (25-70%). [2,3,8] Park et al, [3] reported the incidence of multiple aneurysms to be around 40% while Suzuki et al, [6] reported an incidence of around 44.7%.…”

Section: Discussionmentioning

confidence: 99%

A1-segment aneurysms: Management protocol based on a new classification

et al. 2014

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AI-segment aneurysms have unique properties: rupturing of small-sized aneurysms; multiplicity; undetectable on initial imaging; frontal lobar/intraventricular bleeding; origin from main trunk and not bifurcating points; neck obscuration by AI-trunk; close proximity to perforators; and, associated AI-segment and ACA anomalies. A new classification identifies surgical difficulties inherent in different sites of origin of A1-aneurysms.

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Section: Discussionmentioning

confidence: 99%

A1-segment aneurysms: Management protocol based on a new classification

et al. 2014

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“…In the past, surgical clipping has mainly been performed for treatment of patients with A1 aneurysms. However, endovascular coiling has been used increasingly in recent years and recent articles on endovascular treatment of A1 aneurysms have reported good results 1)5)8)10). A1 aneurysms are less prone to recanalization due to their small size and sidewall aneurysms 10).…”

Section: Discussionmentioning

confidence: 99%

Management of Aneurysms of the Proximal (A1) Segment of the Anterior Cerebral Artery

Park

Choi

Kang

et al. 2013

J Cerebrovasc Endovasc Neurosurg

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ObjectiveAneurysms originating from the proximal segment (A1) of the anterior cerebral artery are rare; however, because of their small size, the risk of injury of perforating arteries, and the location of the aneurysm in the surgical field, they are challenging to treat. We report on 15 patients with A1 aneurysms and review surgical views according to the direction of aneurysms.MethodsFifteen patients were diagnosed with A1 aneurysms and underwent surgical clipping or endovascular coiling at our institution between January 2006 and March 2012. We conducted a retrospective review of clinical and radiological features of all patients with A1 aneurysms.ResultsNine patients underwent surgical clipping, and six patients received endovascular coiling. Six patients (40%) had multiple aneurysms. A1 aneurysms ranged in size from 1.5 to 8.2 mm, with an average size of 3.26 mm. Most A1 aneurysms (73%) had a posterior direction. In the surgical view, A1 aneurysms projecting posteriorly were located behind the A1 trunk. The A1 aneurysm projecting posteroinferiorly was completely eclipsed by the parent artery. In A1 aneurysms with a posterosuperior or superior direction, finding and clipping the aneurysm neck was relatively easy. Thirteen patients (87%) had an excellent outcome, one had moderate disability, and one died.ConclusionA1 aneurysms have certain characteristics; small size, multiple aneurysms, and, usually, a posterior direction. A1 aneurysms with a posterosuperior or superior direction are relatively easy to assess, however, clipping of A1 aneurysms with a posterior or posteroinferior direction is more difficult. Endovascular coiling is an alternative therapeutic option when surgical clipping is expected to be difficult.

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“…When they do occur in the later, they are most commonly found in the middle cerebral artery and internal carotid artery [12]. Fusiform aneurysms that involve the anterior cerebral artery as in our patient are also extremely rare [1,2,4]. Typical presentations of fusiform aneurysms include brain stem and/or cranial nerve compression (basilar artery aneurysm), ische mia secondary to thrombosis, brain stem/cerebellar infarcts with a basilar artery aneurysm or hemorrhage.…”

Section: Discussionmentioning

confidence: 78%