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Anterior Choroidal Artery Aneurysm: Incidental Anterior Choroidal Artery Aneurysm, Treated by Flow Diversion Using a p64 with Preservation of the Anterior Choroidal Artery

  • Muhammad AlMatter
  • Marta Aguilar Pérez
  • Hans Henkes
Living reference work entry

Abstract

A 58-year-old female patient with a medical history of arterial hypertension and a negative family history for cerebrovascular diseases presented with a headache. MRI/MRA revealed an incidental aneurysm of the right internal carotid artery (ICA) at the origin of the anterior choroidal artery (AchoA) with a fundus diameter of 4.9 mm and a neck diameter of 2.9 mm. This aneurysm was given endovascular treatment in which a p64 flow diverter (phenox) was implanted. A follow-up DSA after 3 months showed the complete angiographic occlusion of the aneurysm with a minor in-stent stenosis. DSA runs 9 and 12 months after the endovascular treatment confirmed the persistent aneurysm occlusion, the preservation of the AchoA, and the spontaneous regression of the in-stent stenosis. Flow diverter treatment of AchoA aneurysms is the main topic of this chapter.

Keywords

Anterior choroidal artery Flow diversion Microsurgical clipping Complications In-stent stenosis Side branch occlusion p64 

References

  1. Aguilar Pérez M, Bhogal P, Henkes E, Ganslandt O, Bäzner H, Henkes H. In-stent stenosis after p64 flow diverter treatment. Clin Neuroradiol. 2017;  https://doi.org/10.1007/s00062-017-0591-y.CrossRefGoogle Scholar
  2. André A, Boch AL, Di Maria F, Nouet A, Sourour N, Clémenceau S, Gabrieli J, Degos V, Zeghal C, Chiras J, Cornu P, Clarençon F. Complication risk factors in anterior choroidal artery aneurysm treatment. Clin Neuroradiol. 2017;  https://doi.org/10.1007/s00062-017-0575-y.CrossRefGoogle Scholar
  3. Bhogal P, Ganslandt O, Bäzner H, Henkes H, Pérez MA. The fate of side branches covered by flow diverters – results from 140 patients. World Neurosurg. 2017;103:789–98.  https://doi.org/10.1016/j.wneu.2017.04.092.CrossRefPubMedGoogle Scholar
  4. Bhogal P, Ganslandt O, Bäzner H, Henkes H, Aguilar PM. Treatment of unruptured, saccular, anterior choroidal artery aneurysms with flow diversion: single Centre experience. Clin Neuroradiol. 2018;  https://doi.org/10.1007/s00062-018-0677-1.
  5. Bohnstedt BN, Kemp WJ 3rd, Li Y, Payner TD, Horner TG, Leipzig TJ, Cohen-Gadol AA. Surgical treatment of 127 anterior choroidal artery aneurysms: a cohort study of resultant ischemic complications. Neurosurgery. 2013;73(6):933–9.; discussion 939–940.  https://doi.org/10.1227/NEU.0000000000000131.CrossRefPubMedGoogle Scholar
  6. Brinjikji W, Kallmes DF, Cloft HJ, Lanzino G. Patency of the anterior choroidal artery after flow-diversion treatment of internal carotid artery aneurysms. AJNR Am J Neuroradiol. 2015;36(3):537–41.  https://doi.org/10.3174/ajnr.A4139.CrossRefPubMedGoogle Scholar
  7. Friedman JA, Pichelmann MA, Piepgras DG, Atkinson JL, Maher CO, Meyer FB, Hansen KK. Ischemic complications of surgery for anterior choroidal artery aneurysms. J Neurosurg. 2001;94(4):565–72.  https://doi.org/10.3171/jns.2001.94.4.0565.CrossRefPubMedGoogle Scholar
  8. Gimonet H, Desal HA, Mosimann PJ, Stracke P, Daumas-Duport B, Lintia-Gaultier A, Bourcier R, Chapot R. A new endovascular technique for small anterior choroidal artery aneurysms. A consecutive series using the 3-catheter-protective technique. J Neuroradiol. 2016;43(3):223–6.  https://doi.org/10.1016/j.neurad.2016.02.004.CrossRefPubMedGoogle Scholar
  9. Hou SY, Kühn AL, Puri AS, Wakhloo AK. Open-cell stent and use of cone-beam CT enables a safe and effective coil embolization of true ophthalmic artery and anterior choroidal artery aneurysms with preservation of parent vessel: clinical and angiographic results. Interv Neuroradiol. 2018;24(2):135–9.  https://doi.org/10.1177/1591019917747246.CrossRefPubMedGoogle Scholar
  10. Kühn AL, Hou SY, Perras M, Brooks C, Gounis MJ, Wakhloo AK, Puri AS. Flow diverter stents for unruptured saccular anterior circulation perforating artery aneurysms: safety, efficacy, and short-term follow-up. J Neurointerv Surg. 2015;7(9):634–40.  https://doi.org/10.1136/neurintsurg-2014-011237.CrossRefPubMedGoogle Scholar
  11. Lee YS, Park J. Anterior choroidal artery aneurysm surgery: ischemic complications and clinical outcomes revisited. J Korean Neurosurg Soc. 2013;54(2):86–92.  https://doi.org/10.3340/jkns.2013.54.2.86.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Lehecka M, Dashti R, Laakso A, van Popta JS, Romani R, Navratil O, Kivipelto L, Kivisaari R, Foroughi M, Kokuzawa J, Lehto H, Niemelä M, Rinne J, Ronkainen A, Koivisto T, Jääskelainen JE, Hernesniemi J. Microneurosurgical management of anterior choroid artery aneurysms. World Neurosurg. 2010;73(5):486–99.  https://doi.org/10.1016/j.wneu.2010.02.001.CrossRefPubMedGoogle Scholar
  13. Li J, Mukherjee R, Lan Z, Liu Y, He M. Microneurosurgical management of anterior choroidal artery aneurysms: a 16-year institutional experience of 102 patients. Neurol Res. 2012;34(3):272–80.  https://doi.org/10.1179/1743132812Y.0000000008.CrossRefPubMedGoogle Scholar
  14. Morandi X, Brassier G, Darnault P, Mercier P, Scarabin JM, Duval JM. Microsurgical anatomy of the anterior choroidal artery. Surg Radiol Anat. 1996;18(4):275–80.CrossRefGoogle Scholar
  15. Nadaf S, Chakor RT, Kothari KV, Patel BA. Anterior choroidal artery infarction. BMJ Case Rep. 2018. pii: bcr-2017-222414;  https://doi.org/10.1136/bcr-2017-222414.
  16. Neki H, Caroff J, Jittapiromsak P, Benachour N, Mihalea C, Ikka L, Moret J, Spelle L. Patency of the anterior choroidal artery covered with a flow-diverter stent. J Neurosurg. 2015;123(6):1540–5.  https://doi.org/10.3171/2014.11.JNS141603.CrossRefPubMedGoogle Scholar
  17. Pezzella FR, Vadalà R. Anterior choroidal artery territory infarction. Front Neurol Neurosci. 2012;30:123–7.  https://doi.org/10.1159/000333608.CrossRefPubMedGoogle Scholar
  18. Raz E, Shapiro M, Becske T, Zumofen DW, Tanweer O, Potts MB, Riina HA, Nelson PK. Anterior choroidal artery patency and clinical follow-up after coverage with the pipeline embolization device. AJNR Am J Neuroradiol. 2015;36(5):937–42.  https://doi.org/10.3174/ajnr.A4217.CrossRefPubMedGoogle Scholar
  19. Sheen JJ, Suh DC. Low-angled microcatheter approach for coil embolization of the anterior choroidal artery aneurysm. Neuroradiology. 2017;59(10):1053–6.  https://doi.org/10.1007/s00234-017-1879-y.CrossRefPubMedGoogle Scholar
  20. Srinivasan VM, Ghali MGZ, Cherian J, Mokin M, Puri AS, Grandhi R, Chen SR, Johnson JN, Kan P. Flow diversion for anterior choroidal artery (AChA) aneurysms: a multi-institutional experience. J Neurointerv Surg. 2017. pii: neurintsurg-2017-013466;  https://doi.org/10.1136/neurintsurg-2017-013466.CrossRefGoogle Scholar
  21. Tanriover N, Kucukyuruk B, Ulu MO, Isler C, Sam B, Abuzayed B, Uzan M, Ak H, Tuzgen S. Microsurgical anatomy of the cisternal anterior choroidal artery with special emphasis on the preoptic and postoptic subdivisions. J Neurosurg. 2014;120(5):1217–28.  https://doi.org/10.3171/2014.1.JNS131325.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Muhammad AlMatter
    • 1
  • Marta Aguilar Pérez
    • 1
  • Hans Henkes
    • 1
  1. 1.Neuroradiologische Klinik, NeurozentrumKlinikum StuttgartStuttgartGermany

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