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Neuroradiology

, Volume 56, Issue 3, pp 219–225 | Cite as

Coil embolization in precommunicating (A1) segment aneurysms of anterior cerebral artery

  • Young Dae Cho
  • Jun Hyong Ahn
  • Seung Chai Jung
  • Chang Hun Kim
  • Hyun-Seung KangEmail author
  • Jeong Eun Kim
  • Young Je Son
  • Moon Hee Han
Interventional Neuroradiology

Abstract

Introduction

Precommunicating (A1) segment aneurysms of the anterior cerebral artery are rare and often pose technical challenges for coil embolization due to their distinctive configurations. Clinical and radiologic outcomes of treating such aneurysms through endovascular coil embolization are presented herein.

Methods

Data accruing prospectively from May 2002 to August 2013 yielded 48 patients harboring 50 A1 segment aneurysms, each classified as proximal, middle, or distal by location. Clinical outcome of the patients and morphological outcome of the aneurysms were assessed, with emphasis on technical aspects of treatment.

Results

The aneurysms studied occupied either proximal (n = 39), middle (n = 6), or distal (n = 5). Proximal aneurysms were largely directed posteriorly (80 %), and most (97 %) were devoid of branches. Middle and distal aneurysms were associated with the medial lenticulostriate artery, cortical branches, or fenestrations. The preshaped “S” and steam-shaped “S” microcatheters facilitated aneurysm selection in 60 % of lesions. Single-microcatheter technique was most commonly applied for coil embolization (62 %), followed by balloon protection (16 %). Successful aneurysmal occlusion could be achieved in 76 % of the patients, with no procedure-related morbidity and mortality. At final follow-up (mean interval, 29.9 months), stable aneurysmal occlusion was sustained in 93 % of the patients (40/43).

Conclusion

A1 segment aneurysms are amenable to safe and efficacious endovascular coil embolization by adjusting procedural strategy to accommodate distinctive anatomic configurations.

Keywords

Aneurysm Coil Embolization Anterior cerebral artery 

Notes

Acknowledgments

This study was supported by a grant of the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare and Family Affairs, Republic of Korea (A111101).

Conflict of interest

We declare that we have no conflict of interest.

References

  1. 1.
    Cho YD, Lee WJ, Kim KM et al (2013) Endovascular coil embolization of middle cerebral artery aneurysms of the proximal (M1) segment. Neuroradiology 55:1097–1102PubMedCrossRefGoogle Scholar
  2. 2.
    Cho YD, Lee JY, Seo JH et al (2013) Coil protection using small helical coils for wide-neck intracranial aneurysms: a novel approach. AJNR Am J Neuroradiol 34:164–168PubMedCrossRefGoogle Scholar
  3. 3.
    Gordhan A (2011) Microcatheter neck bridging and incorporated branch vessel protection for coil embolization of a wide-neck ruptured aneurysm: technical case report. Neurosurgery 68:40–43PubMedCrossRefGoogle Scholar
  4. 4.
    Peluso JP, van Rooij WJ, Sluzewski M et al (2008) A new self-expandable nitinol stent for the treatment of wide-neck aneurysms: initial clinical experience. AJNR Am J Neuroradiol 29:1405–1408PubMedCrossRefGoogle Scholar
  5. 5.
    Weber W, Bendszus M, Kis B et al (2007) A new self-expanding nitinol stent (enterprise) for the treatment of wide-necked intracranial aneurysms: initial clinical and angiographic results in 31 aneurysms. Neuroradiology 49:555–561PubMedCrossRefGoogle Scholar
  6. 6.
    Shapiro M, Babb J, Becske T et al (2008) Safety and efficacy of adjunctive balloon remodeling during endovascular treatment of intracranial aneurysms: a literature review. AJNR Am J Neuroradiol 29:1777–1781PubMedCrossRefGoogle Scholar
  7. 7.
    Pierot L, Cognard C, Spelle L et al (2012) Safety and efficacy of balloon remodeling technique during endovascular treatment of intracranial aneurysms: critical review of the literature. AJNR Am J Neuroradiol 33:12–15PubMedCrossRefGoogle Scholar
  8. 8.
    Lee JY, Seo JH, Cho YD et al (2011) Endovascular treatment of wide-neck intracranial aneurysms using a microcatheter protective technique: results and outcomes in 75 aneurysms. AJNR Am J Neuroradiol 32:917–922PubMedCrossRefGoogle Scholar
  9. 9.
    Biondi A, Janardhan V, Katz JM et al (2007) Neuroform stent-assisted coil embolization of wide-neck intracranial aneurysms: strategies in stent deployment and midterm follow-up. Neurosurgery 61:460–468PubMedCrossRefGoogle Scholar
  10. 10.
    Lubicz B, Lefranc F, Levivier M et al (2006) Endovascular treatment of intracranial aneurysms with a branch arising from the sac. AJNR Am J Neuroradiol 27:142–147PubMedGoogle Scholar
  11. 11.
    Chang HW, Youn SW, Jung C et al (2011) Technical strategy in endovascular treatment of proximal anterior cerebral artery aneurysms. Acta Neurochir (Wien) 153:279–285CrossRefGoogle Scholar
  12. 12.
    Suzuki M, Onuma T, Sakurai Y et al (1992) Aneurysms arising from the proximal (A1) segment of the anterior cerebral artery. A study of 38 cases. J Neurosurg 76:455–458PubMedCrossRefGoogle Scholar
  13. 13.
    Wanibuchi M, Kurokawa Y, Ishiguro M et al (2001) Characteristics of aneurysms arising from the horizontal portion of the anterior cerebral artery. Surg Neurol 55:148–154PubMedCrossRefGoogle Scholar
  14. 14.
    Dashti R, Hernesniemi J, Lehto H et al (2007) Microneurosurgical management of proximal anterior cerebral artery aneurysms. Surg Neurol 68:366–377PubMedCrossRefGoogle Scholar
  15. 15.
    Hino A, Fujimoto M, Iwamoto Y et al (2002) Surgery of proximal anterior cerebral artery aneurysms. Acta Neurochir (Wien) 144:1291–1296CrossRefGoogle Scholar
  16. 16.
    Park J, Baik SK Posterior projecting carotid-A1 junctional aneurysms. Acta Neurochir (Wien) 149:817–821Google Scholar
  17. 17.
    Lubicz B, Bruneau M, Dewindt A et al (2009) Endovascular treatment of proximal anterior cerebral artery aneurysms. Neuroradiology 51:99–102PubMedCrossRefGoogle Scholar
  18. 18.
    Kang HS, Kwon BJ, Kim JE et al (2010) Preinterventional clopidogrel response variability for coil embolization of intracranial aneurysms: clinical implications. AJNR Am J Neuroradiol 31:1206–1210PubMedCrossRefGoogle Scholar
  19. 19.
    Raymond J, Guilbert F, Weill A et al (2003) Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34:1398–1403PubMedCrossRefGoogle Scholar
  20. 20.
    Kang HS, Han MH, Kwon BJ et al (2005) Short-term outcome of intracranial aneurysms treated with polyglycolic acid/lactide copolymer-coated coils compared to historical controls treated with bare platinum coils: a single-center experience. AJNR Am J Neuroradiol 26:1921–1928PubMedGoogle Scholar
  21. 21.
    Lee SJ, Cho YD, Kang HS et al (2013) Coil embolization using the self-expandable closed-cell stent for intracranial saccular aneurysm: A single-center experience of 289 consecutive aneurysms. Clin Radiol 68:256–263PubMedCrossRefGoogle Scholar
  22. 22.
    Cho YD, Kang HS, Kim JE et al (2012) Microcatheter looping technique for coil embolization of complex configuration middle cerebral artery aneurysms. Neurosurgery 71:1185–1191PubMedCrossRefGoogle Scholar
  23. 23.
    Wakabayashi T, Tamaki N, Yamashita H et al (1985) Angiographic classification of aneurysms of the horizontal segment of the anterior cerebral artery. Surg Neurol 24:31–34PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Young Dae Cho
    • 1
  • Jun Hyong Ahn
    • 1
  • Seung Chai Jung
    • 1
  • Chang Hun Kim
    • 1
  • Hyun-Seung Kang
    • 2
    Email author
  • Jeong Eun Kim
    • 2
  • Young Je Son
    • 3
  • Moon Hee Han
    • 1
    • 2
  1. 1.Department of RadiologySeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
  2. 2.Department of NeurosurgerySeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
  3. 3.Department of NeurosurgerySeoul National University Boramae Hospital, Seoul National University College of MedicineSeoulSouth Korea

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