Article
Endovascular embolization of aneurysms of the distal anterior cerebral artery
Endovaskuläre Therapie von Aneurysmen der Arterie pericallosa
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Authors
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S. Göricke
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen
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A. Dörfler
- Abteilung für Neuroradiologie, Universitätsklinikum Erlangen
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I. Wanke
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen
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J. Regel
- Klinik und Poliklinik für Neurochirurgie Essen, Universitätsklinikum Essen
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D. Stolke
- Klinik und Poliklinik für Neurochirurgie Essen, Universitätsklinikum Essen
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M. Forsting
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen
| Published: | May 8, 2006 |
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Outline
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Objective: To analyze technical feasibility and efficacy of endovascular occlusion of aneurysms at the distal anterior cerebral artery.
Methods: Eighteen patients harboring 20 aneurysms were considered for endovascular therapy using electrolytically detachable coils (GDC, Boston Scientific; EDC, Dendron-MTI). Aneurysm size was: <4 mm (n=12), 4-6 mm (n=7), >6 mm (n=1). 17 patients had a SAH, 13 bled from a ruptured aneurysm of the distal anterior cerebral artery, four patients due to an additional aneurysm (MCA n=3, Pcom n=1). Patients with SAH were classified as H&H Grade I (n=5), II (n=4), III (n=4), IV (n=3), and V (n=1). At the time of treatment four patients had severe vasospasm. Occlusion rate was divided into total (100%), subtotal (95-99%) and incomplete (<95%) occlusion. Up to the present follow-up angiography, MR angiography and clinical evaluation based on Glasgow outcome scale (GOS) was performed in 17 pts. at 6 months.
Results: Embolization with total occlusion was performed in 16/20 aneurysms. Two patients with severe vasospasm could be embolized following administration of papaverine. In 4/20 aneurysms coil embolization was not feasable because of an unfavorable broad-based aneurysm anatomy (n=2) and severe vasospasm (n=2). Three of these patients were treated surgically, one (H&H V) died prior surgery. Procedural complication included one aneurysm perforation without neurologic deterioration. There was no procedure-related death. One day after angiography one patient suffered from a hemiparesis by thromboembolic MCA occlusion, which was successfully thrombolyzed, but remained as MCA infarction in CT. Ischemic infarction was also visible in two other pts. on routine CT. During follow-up two aneurysms initially total occluded then showed subtotal and incomplete occlusion, probably due to recanalization of a partially thrombosed aneurysm compartment. During 6 month follow-up no patient rebled. GOS was: GR (n=7), MD (n=4), SD (n=5), V (n=1).
Conclusions: Endovascular coil embolization of ruptured and unruptured aneurysms of the distal anterior cerebral artery can be performed effectively and may be a less invasive therapeutic alternative to surgery, especially during the vulnerable vasospasm period. However, comparable to surgery an unfavorable aneurysm anatomy or severe vasospasm may limit endovascular treatment possibilities in this location.
