Endovascular Treatment of ACom Intracranial Aneurysms

Abstract

The immediate and long-term outcomes, complications, recurrences and the need for retreatment were analyzed in a series of 280 consecutive patients with anterior communicating artery aneurysms treated with the endovascular technique. From October 1992 to October 2001 280 patients with 282 anterior communicating artery aneurysms were addressed to our center. For the analysis, the population was divided into two major groups: group 1, comprising 239 (85%) patients with ruptured aneurysms and group 2 comprising of 42 (15%) patients with unruptured aneurysms. In group 1, 185 (77.4%) patients had a good initial pre-treatment Hunt and Hess grade of I-III. Aneurysm size was divided into three categories according to the larger diameter: less than 4 mm, between 4 and 10 mm and larger than 10 mm. The sizes of aneurysms in groups 1 and 2 were identical but a less favorable neck to depth ratio of 0.5 was more frequent in group 2.

Endovascular treatment was finally performed in 234 patients in group 1 and 34 patients in group 2. Complete obliteration was more frequently obtained in group 2 unlike a residual neck or opacification of the sac that were more frequently seen in group 1. No peri-treatment complications were recorded in group 2. In group 1 the peri-treatment mortality and overall peri-treatment morbidity were 5.1% and 8.1% respectively. Eight patients (3.4%) in group 1 presented early post treatment rebleeding with a mortality of 88%. The mean time to follow-up was 3.09 years. In group 1, 51 (21.7%) recurrences occurred of which 14 were minor and 37 major. In group 2, eight (23.5%) recurrences occurred, five minor and three major. Two patients (0.8%) presented late rebleeding in group 1.

Twenty-seven second endovascular retreatments were performed, 24 (10.2%) in group 1 and three (8.8%) in group 2, seven third endovascular retreatments and two surgical clippings in group 1 only. There was no additional morbidity related to retreatments.

Endovascular treatment is an effective method for the treatment of anterior communicating artery aneurysms allowing late rebleeding prevention. Peri-treatment rebleeding warrants caution in anticoagulation management. This is a single center experience and the follow-up period is limited. Patients should be followed-up in the long-term as recurrences may occur and warrant additional treatment.

Keywords

brain cerebral anterior communicating aneurysm

Get full access to this article

View all access options for this article.

References

Murayama

Nien

: Guglielmi detachable coil embolization of cerebral aneurysms: 11 years' experience. J Neurosurg 98: 959–966, 2003.

Gonzalez

Murayama

: Treatment of unruptured aneurysms with GDCs: clinical experience with 247 aneurysms. Am J Neuroradiol 25: 577–583, 2004.

Graves

Strother

: Early treatment of ruptured aneurysms with Guglielmi detachable coils: effect on subsequent bleeding. Neurosurgery 37: 640–647; discussion 647–648, 1995.

Guglielmi

Viñuela

: Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. J Neurosurg 75: 8–14, 1991.

Moret

Pierot

: Endovascular treatment of anterior communicating artery aneurysms using Guglielmi detachable coils. Neuroradiology 38: 800–805, 1996.

Murayama

Viñuela

: Embolization of incidental cerebral aneurysms by using the Guglielmi detachable coil system. J Neurosurg 90: 207–214, 1999.

Nichols

Brown

Jr : Endovascular treatment of ruptured posterior circulation aneurysms using electrolytically detachable coils. J Neurosurg 87: 374–380, 1997.

Raymond

Roy

: Endovascular treatment of acutely ruptured and unruptured aneurysms of the basilar bifurcation. J Neurosurg 86: 211–219, 1997.

Viñuela

Duckwiler

Mawad

: Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86: 475–482, 1997.

10.

Yundt

Dacey

Jr. Diringer

: Hospital resource utilization in the treatment of cerebral aneurysms. J Neurosurg 85: 403–409, 1996.

11.

Ogungbo

Gregson

: Trends over time in the management of subarachnoid haemorrhage in Newcastle: review of 1609 patients. Br J Neurosurg 15: 388–395, 2001.

12.

Sim

: Intracranial aneurysms in Korea. Neurol Med Chir (Tokyo) 38 Sup: 118–121, 1998.

13.

Kassell

Torner

: The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results. J Neurosurg 73: 18–36, 1990.

14.

Le Roux

Elliott

: Risks and benefits of diagnostic angiography after aneurysm surgery: a retrospective analysis of 597 studies. Neurosurgery 42:1248–1254; discussion 1254–1245, 1998.

15.

Molyneux

Kerr

: International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360: 1267–1274, 2002.

16.

Henkes

Fischer

: Endovascular coil occlusion of 1811 intracranial aneurysms: early angiographic and clinical results. Neurosurgery 54: 268–280; discussion 280–265, 2004.

17.

Proust

Debono

: Treatment of anterior communicating artery aneurysms: complementary aspects of microsurgical and endovascular procedures. J Neurosurg 99: 3–14, 2003.

18.

Moret

Cognard

: Reconstruction technic in the treatment of wide-neck intracranial aneurysms. Long-term angiographic and clinical results. Apropos of 56 cases. J Neuroradiol 24: 30–44, 1997.

19.

Willinsky

Peltz

: Clinical and Angiographic Follow-up of Ruptured Intracranial Aneurysms Treated with Endovascular Embolization. Am J Neuroradiol 30: 1035–1040, 2009.

20.

Drake

Peerless

Hernesniemi

: Complications of surgery for vertebrobasilar artery aneurysms and final comments, in Drake

(ed) Surgery of Vertebrobasilar Aneurysms: London, Ontario, Experience on 1, 767 Patients. New York, NY, Springer-Verlage, 1996, 300–311.

21.

Drake

Friedman

Peerless

: Failed aneurysm surgery. Reoperation in 115 cases. J Neurosurg 61: 848–856, 1984.

22.

Feuerberg

Lindquist

: Natural history of postoperative aneurysm rests. J Neurosurg 66: 30–34, 1987.

23.

Fox

Drake

: Aneurysm neck remnant following balloon embolization. J Neurosurg 67: 321–323, 1987.

24.

Giannotta

Litofsky

: Reoperative management of intracranial aneurysms. J Neurosurg 83: 387–393, 1995.

25.

Heilman

Kwan

: Aneurysm recurrence following endovascular balloon occlusion. J Neurosurg 77: 260–264, 1992.

26.

Hodes

Fox

: Rupture of aneurysms following balloon embolization. J Neurosurg 72: 567–571, 1990.

27.

Koivisto

Vanninen

: Outcomes of early endovascular versus surgical treatment of ruptured cerebral aneurysms. A prospective randomized study. Stroke 31: 2369–2377, 2000.

28.

Lin

Fox

Drake

: Regrowth of aneurysm sacs from residual neck following aneurysm clipping. J Neurosurg 70: 556–560, 1989.

29.

Elias

Ogungbo

: Endovascular treatment of anterior communicating artery aneurysms: results of clinical and radiological outcome in Newcastle. Br J Neurosurg 17: 278–286, 2003.

30.

Gallas

Pasco

: A multicenter study of 705 ruptured intracranial aneurysms treated with Guglielmi detachable coils. Am J Neuroradiol 26:1723–1731, 2005.

31.

Raymond

Guilbert

: Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34: 1398–1403, 2003.

32.

Turjman

Massoud

: Predictors of aneurysmal occlusion in the period immediately after endovascular treatment with detachable coils: a multivariate analysis. Am J Neuroradiol 19:1645–1651, 1998.

33.

Chan

: Intracranial aneurysms treated with Guglielmi detachable coils: midterm clinical and radiological outcome in 97 consecutive Chinese patients in Hong Kong. Am J Neuroradiol 25: 307–313, 2004.

34.

Bracard

Lebedinsky

: Endovascular treatment of Hunt and Hess grade IV and V aneuryms. Am J Neuroradiol 23: 953–957, 2002.

35.

Weir

Marcellus

: Aneurysmal subarachnoid hemorrhage in patients with Hunt and Hess grade 4 or 5: treatment using the Guglielmi detachable coil system. Am J Neuroradiol 24: 585–590, 2003.

36.

Diraz

Kobayashi

: Surgical approaches to the anterior communicating artery aneurysm and their results. Neurol Res 15: 273–280, 1993.

37.

French

Zarling

Schultz

: Management of aneurysms of the anterior communicating artery. J Neurosurg 19: 870–876, 1962.

38.

Hori

Suzuki

: Early and late results of intracranial direct surgery of anterior communicating artery aneurysms. J Neurosurg 50: 433–440, 1979.

39.

Keogh

Sharma

Vanner

: The anterior interhemispheric trephine approach to anterior midline aneurysms: results of treatment in 72 consecutive patients. Br J Neurosurg 7: 5–12, 1993.

40.

Nathal

Yasui

: Intraoperative anatomical studies in patients with aneurysms of the anterior communicating artery complex. J Neurosurg 76: 629–634, 1992.

41.

Ogawa

Suzuki

: Vascular anomalies associated with aneurysms of the anterior communicating artery: microsurgical observations. J Neurosurg 72:706–709, 1990.

42.

Sengupta

: Anterior communicating aneurysm: its surgical approach and results, in Suzuki

(ed) Advances in Surgery for Cerebral Stroke. Berlin, Springer-Verlag: 269–274, 1988.

43.

Sengupta

Chiu

Brierley

: Quality of survival following direct surgery for anterior communicating artery aneurysms. J Neurosurg 43: 58–64, 1975.

44.

Yasargil

: Microneurosurgery: In 4 Volumes, in. New York, Thieme: 180–185, 1984.

45.

Gruber

Killer

: Clinical and angiographic results of endosaccular coiling treatment of giant and very large intracranial aneurysms: a 7-year, single-center experience. Neurosurgery 45: 793–803; discussion 803–794, 1999.

46.

Kuether

Nesbit

Barnwell

: Clinical and angiographic outcomes, with treatment data, for patients with cerebral aneurysms treated with Guglielmi detachable coils: a single-center experience. Neurosurgery 43:1016–1025, 1998.

47.

Pelz

Lownie

Fox

: Thromboembolic events associated with the treatment of cerebral aneurysms with Guglielmi detachable coils. Am J Neuroradiol 19: 1541–1547, 1998.

48.

Solander

Ulhoa

: Endovascular treatment of multiple intracranial aneurysms by using Guglielmi detachable coils. J Neurosurg 90: 857–864, 1999.

49.

Iijima

Piotin

: Endovascular treatment with coils of 149 middle cerebral artery berry aneurysms. Radiology 237: 611–619, 2005.

50.

Brisman

Niimi

: Aneurysmal rupture during coiling: low incidence and good outcomes at a single large volume center. Neurosurgery 57: 1103–1109; discussion 1103–1109, 2005.

51.

Sluzewski

van Rooij

: Early rebleeding after coiling of ruptured cerebral aneurysms: incidence, morbidity, and risk factors. Am J Neuroradiol 26: 1739–1743, 2005.

52.

Cognard

Weill

Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology 212: 348–356, 1999.

53.

Thornton

Debrun

: Follow-up angiography of intracranial aneurysms treated with endovascular placement of Guglielmi detachable coils. Neurosurgery 50: 239–249; discussion 249–250, 2002.

54.

Henkes

Fischer

: Repeated endovascular coil occlusion in 350 of 2759 intracranial aneurysms: safety and effectiveness aspects. Neurosurgery 58: 224–232; discussion 224–232, 2006.