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Cho WC, Choi JH, Lee KS, Kim BS, Shin YS. Risk Factors for the Recurrence of Distal Anterior Cerebral Artery Aneurysms After Endovascular Treatment. World Neurosurg 2024; 186:e481-e486. [PMID: 38583568 DOI: 10.1016/j.wneu.2024.03.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE We aimed to investigate risk factors for the recurrence of distal anterior cerebral artery (DACA) aneurysms after endovascular treatment (EVT). METHODS The clinical and radiologic outcomes of DACA aneurysms treated with endovascular methods at a single tertiary hospital from September 2008 to December 2021 were retrospectively reviewed. We measured the angle between 2 distal branches of DACA aneurysms and categorized the angle as follows: 1) wide-angle (≥180°), and 2) narrow-angle type configuration (<180°). Univariate and multivariate analyses were performed to demonstrate the relationships between characteristics of DACA aneurysm and recurrence risk. RESULTS In total, 132 DACA aneurysms were treated in our institution. Among these, 47 DACA aneurysms after EVT were included in this study. Forty patients underwent coil embolization without stent, 7 for stent-assisted coil embolization. At the last follow-up (mean 30.2 ± 24.2 months), overall recurrence rate was 23.4% (n = 11). Recurrence rate of the wide-angle type (9 of 23, 39.1%) was significantly greater than narrow-angle type (2 of 24, 8.3%) (P = 0.041; odds ratio 8.174, 95% confidence interval 1.094-61.066). Irregular shape of the DACA aneurysm also showed significantly greater recurrence rate (P = 0.011; odds ratio 10.663, 95% confidence interval 1.701-66.838) after endovascular treatment. CONCLUSIONS The wide-angle between 2 distal branches of DACA aneurysm and irregular shape might be independent risk factors for the recurrence after endovascular treatment for DACA aneurysms.
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Affiliation(s)
- Woo Cheul Cho
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Jai Ho Choi
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea.
| | - Kwan Sung Lee
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Bum-Soo Kim
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Yong Sam Shin
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea
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Conte M, Cagil E, Lanzino G, Keser Z. Fusiform aneurysms of anterior cerebral artery: center experience and systematic literature review. Neurosurg Rev 2023; 47:11. [PMID: 38087068 DOI: 10.1007/s10143-023-02247-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/12/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023]
Abstract
Fusiform aneurysms of the anterior cerebral artery (ACA) are uncommon, and the natural history of this entity is poorly characterized. Along with our center experience, we conducted a systematic literature review to help shed light on the clinical course of ACA fusiform aneurysms. We queried our institutional database to identify cases with fusiform aneurysms of ACA. In addition, following the PRISMA algorithm, we identified all reported cases published in the English literature from the inception of PubMed until December 2022. We categorized clinical presentations into three categories: (i) traumatic/iatrogenic, (ii) spontaneous symptomatic ruptured/unruptured, and (iii) spontaneous asymptomatic aneurysms. We utilized descriptive statistics. We identified seven cases from our center along with 235 patients from published literature. Blunt trauma was responsible for the development of 19 aneurysms. Sixty-three percent of these aneurysms tend to rupture within 2 weeks from the initial trauma, and despite treatment, only 74% of these patients had good clinical outcomes. Spontaneous symptomatic presentation occurred in 207 patients and was often associated with previous/concomitant ACA dissection. Subarachnoid hemorrhage from ruptured aneurysms was the most common presentation. Spontaneous symptomatic fusiform aneurysm is rapidly evolving lesions, and treatment is necessary. Three of our own cases were treated with an endovascular flow diverter (pipeline) stenting with good outcomes. Spontaneous asymptomatic aneurysms were reported in nine patients. These lesions are often associated with other vascular abnormalities. Treatment included surgical clipping with good clinical outcomes. Instead, four patients from our center database were managed conservatively with equally good outcomes. Our study demonstrates good clinical outcomes when fusiform aneurysms of ACA, especially when symptomatic, are treated promptly with either reconstructive or deconstructive therapies.
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Affiliation(s)
- Matteo Conte
- University of Padua, Padua, Italy
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Emin Cagil
- Department of Neurosurgery, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey
| | | | - Zafer Keser
- Department of Neurology, Cerebrovascular Division, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
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Sharma GR, Karki P, Joshi S, Paudel P, Shah DB, Baburam P, Bidhan G. Factors Affecting the Outcome after Surgical Clipping of Ruptured Distal Anterior Cerebral Artery (DACA) Aneurysms. Asian J Neurosurg 2023; 18:557-566. [PMID: 38152539 PMCID: PMC10749838 DOI: 10.1055/s-0043-1771371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Objective The purpose of this study is to assess demographic, clinical, and unique morphological characteristics of distal anterior cerebral artery (DACA) aneurysm. The relation of outcome included Glasgow Outcome Scale (GOS) using various independent variables, Hunt and Hess clinical grade (H&H), Miller Fischer grade, intraoperative rupture, and comparison of outcomes at discharge and last follow-up. Methods Demographic data, aneurysm characteristics, and treatment outcomes were evaluated in 28 ruptured DACA aneurysms operated over a period of 13 years. Association between independent variables and dependent variables (GOS) at discharge and at last follow-up (13 years) was analyzed, and the interrelationship between these factors and outcome was evaluated. GOS was used to assess functional outcomes. Results Over a period of 13 years, 500 patients harboring ruptured intracranial aneurysms were surgically clipped, and out of them 28 patients (5.6%) had ruptured DACA aneurysms. In this series, 20 (71.4%) patients had low grade and 8 (28.6%) had high grade H&H. Out of the 28 patients, 19 (67.8%) had good recovery, 6 (21.5%) were severely disabled, and 3 (10.7%) died at the time of discharge. On the last follow-up (13 years), smoking ( p -value 0.03) and use of temporary clip ( p -value 0.00) were significant predictors for unfavorable outcome. Conclusion The results of our case series show that even with ruptured aneurysm excellent overall outcome after microsurgical clipping can be achieved, even though among cerebral aneurysms, DACA aneurysm is considered to have less favorable outcome. Alcohol consumption and use of temporary clip were the predictors for unfavorable outcome at the time of discharge. On the last follow-up, smoking and use of temporary clip were found to be the risk factors for unfavorable outcome. Although the small sample size of this study is a limitation, smoking and use of temporary clip play an important role on the overall outcome. The aim of this study was to analyze data to determine factors which may influence outcome after surgical clipping of ruptured DACA aneurysms.
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Affiliation(s)
| | - Prasanna Karki
- Department of Neurosciences, Nepal Mediciti Hospital, Lalitpur, Nepal
| | - Sumit Joshi
- Department of Neurosciences, Nepal Mediciti Hospital, Lalitpur, Nepal
| | - Prakash Paudel
- Department of Neurosciences, Nepal Mediciti Hospital, Lalitpur, Nepal
| | | | - Pokharel Baburam
- Department of Neurosciences, Nepal Mediciti Hospital, Lalitpur, Nepal
| | - Gyawali Bidhan
- Department of Neurosciences, Nepal Mediciti Hospital, Lalitpur, Nepal
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Treatment outcome of coil embolization for distal anterior cerebral artery aneurysms: A single-center experience. J Stroke Cerebrovasc Dis 2022; 31:106811. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/21/2022] Open
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Contralateral transradial access for coil embolization of distal anterior cerebral artery aneurysm associated with a steep ipsilateral A1-A2 angle. J Stroke Cerebrovasc Dis 2022; 31:106299. [PMID: 35033987 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/25/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Endovascular treatment of distal anterior cerebral artery aneurysms is commonly addressed via the ipsilateral A1 segment of the anterior cerebral artery. However, when the parent pericallosal artery has a sharp ipsilateral A1-A2 angle, catheterization through the ipsilateral A1 segment can potentially result in vessel injury, catheter kinking, and/or compromised/stagnant anterior cerebral artery flow. Here, we present a case of a distal anterior cerebral artery aneurysm associated with a steep ipsilateral A1-A2 angle treated with contralateral transradial coil embolization. CASE PRESENTATION A 91-year-old woman presented with a ruptured left distal anterior cerebral artery aneurysm at the A3 segment. The parent pericallosal artery had a steep ipsilateral A1-A2 angle. To safely achieve coil embolization of the aneurysm, a contralateral transradial system via the right A1 segment was employed. Although a secondary ipsilateral transradial system was required for contrast injection, aneurysm obliteration was successfully achieved without vessel injury or system instability. CONCLUSION The A1-A2 angle can be a key anatomical factor in the endovascular treatment of distal anterior cerebral artery aneurysms. The contralateral transradial system is a useful treatment option for distal anterior cerebral artery aneurysms associated with sharp ipsilateral A1-A2 angles. However, if the distal anterior cerebral artery aneurysm cannot be clearly visualized through the contralateral system, an ipsilateral system will be required for contrast injection.
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Lingaraju T, Shukla D. Clipping and Coiling with the Same Hand. J Neurosci Rural Pract 2021; 12:613. [PMID: 34737492 PMCID: PMC8559071 DOI: 10.1055/s-0041-1736153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- T.S. Lingaraju
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Beydoun HA, Beydoun M, Zonderman A, Eid SM. Perioperative Ischemic Stroke in Unruptured Intracranial Aneurysm Surgical or Endovascular Therapy. Cureus 2020; 12:e7645. [PMID: 32411547 PMCID: PMC7217236 DOI: 10.7759/cureus.7645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Ischemic stroke among hospitalized patients who underwent surgical or endovascular therapies for unruptured intracranial aneurysms (IAs) has not been previously examined in nationally representative samples. Objectives: The purpose of this study is to compare the occurrence and in-hospital outcomes (nonroutine discharge, length of stay) of perioperative ischemic stroke among hospitalized patients diagnosed with unruptured IA across treatment selection [surgical clipping, endovascular coiling, stent- or balloon-assisted coiling (SAC or BAC), combined clipping and coiling]. Methods: A cross-sectional study was conducted using 23,053 hospital discharge records from the 2002-2012 Nationwide Inpatient Sample (NIS). Rates, β coefficients, and odds ratios (ORs) with their 95% confidence intervals (CIs) were calculated accounting for survey design complexity, patient- and hospital-level confounders. Results: Ischemic stroke rate was 6.9% [surgical clipping (4.3%), endovascular coiling (8.1%), BAC or SAC (1.9%), and combined techniques (4.2%)]. Multivariable logistic regression models suggested that compared to patients undergoing surgical clipping alone, those undergoing SAC or BAC were less likely to be diagnosed with ischemic stroke (adjusted OR=0.34, 95% CI: 0.14, 0.85). Compared to clipping, endovascular techniques resulted in fewer nonroutine dispositions and shorter hospitalizations, whereas combined techniques resulted in longer hospitalizations. Differences in hospitalization outcomes between treatment types were only affected by ischemic stroke when comparing coiling to clipping. Conclusions: Perioperative ischemic stroke rate among patients with unruptured IA may be less among those undergoing SAC or BAC as compared to those undergoing surgical clipping alone. Improved in-hospital outcomes among coiling versus clipping recipients may depend on ischemic stroke diagnosis.
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Affiliation(s)
- Hind A Beydoun
- Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, USA
| | - May Beydoun
- Intramural Research Program, National Institute on Aging, Baltimore, USA
| | - Alan Zonderman
- Intramural Research Program, National Institute on Aging, Baltimore, USA
| | - Shaker M Eid
- Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
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Safety and efficacy of different therapeutic strategies in the endovascular treatment of anterior cerebral artery aneurysms with different features: A single centre experience. Clin Neurol Neurosurg 2020; 193:105786. [PMID: 32200221 DOI: 10.1016/j.clineuro.2020.105786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/25/2020] [Accepted: 03/13/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Outcomes of endovascular treatment of anterior cerebral artery (ACA) aneurysms are still not well-characterized. OBJECTIVE The study aimed to review the clinical effect, procedure-related complications and follow-up outcomes and to evaluate the safety and efficacy of endovascular treatment of ACA aneurysms in our center experience. METHODS From August 2014 to August 2018, a total of 75 consecutive patients with 77 ACA aneurysms were treated via the endovascular approach after providing informed consent. A retrospective review of the clinical, radiological, and endovascular details of these patients was conducted. RESULTS The mortality and the morbidity in this study were 4% and 9.3%, respectively. Compared with A1 and A2 aneurysms, intraoperative rupture was more common in A3 aneurysms (P = 0.029). Difference between the ruptured and unruptured aneurysms in the distribution of therapeutic strategy (P = 0.003) and immediate embolization degree (P = 0.004) was also significant. Statistical analysis demonstrated that the larger aneurysm (P = 0.031) was, the greater the ratio of aneurysm size to parent artery diameter (P = 0.029) was, the more likely the unruptured aneurysms were to occur ischemic events. Higher Hunt-Hess grade (P = 0.0066) was an independent risk factor for poor clinical outcome. CONCLUSION Endovascular treatment is feasible and effective for ACA aneurysms.
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Tsunoda S, Yoshikawa G, Ishikawa O. One-stage Operation with Ipsilateral Two-Piece Craniotomies for a Case of Subarachnoid Hemorrhage with Multiple Intracranial Aneurysms. Asian J Neurosurg 2020; 14:1226-1230. [PMID: 31903368 PMCID: PMC6896625 DOI: 10.4103/ajns.ajns_165_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Subarachnoid hemorrhage (SAH) with multiple intracranial aneurysms is common, but the difficulties often arise in determining treatment strategy in the acute phase. We experienced a case of SAH with distal anterior cerebral artery aneurysm coexisting with middle cerebral artery and anterior communicating artery aneurysms, in which it was difficult to identify the precise rupture site preoperatively, and both pterional approach and interhemispheric approach were required in the acute phase of SAH. However, we could treat whole aneurysms in one stage and obtained an excellent outcome using our surgical procedure with ipsilateral frontotemporal and frontal parasagittal craniotomies through a single skin incision.
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Affiliation(s)
- Sho Tsunoda
- Department of Neurosurgery, Showa General Hospital, Tokyo, Japan.,Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan
| | | | - Osamu Ishikawa
- Department of Neurosurgery, Showa General Hospital, Tokyo, Japan.,Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
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Zhou J, Wang Y, Wang D, Chen Q, Wang H, Gao L. Endovascular Treatment for Ruptured Aneurysms at Distal Cerebral Arteries. World Neurosurg 2018; 123:e387-e392. [PMID: 30500584 DOI: 10.1016/j.wneu.2018.11.178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 11/17/2018] [Accepted: 11/19/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the feasibility and efficacy of endovascular treatment for ruptured aneurysms at distal cerebral arteries. METHODS A total of 30 ruptured aneurysms at distal cerebral arteries in 30 patients received endovascular treatment (EVT). Distal cerebral arteries were defined as arteries distal to the A2 or M2 segmentations in the anterior circulation, distal to the P2 segmentation in the posterior circulation, or other small branches or perforating arteries. Aneurysm occlusion was assessed using Raymond classification immediately after the procedure and during angiographic follow-up. Clinical follow-up data were retrospectively analyzed and categorized using the modified Rankin scale (MRS). RESULTS Thirty aneurysms were classified as distal anterior circulation in 17 aneurysms and posterior circulation in 13 aneurysms. EVT technically succeeded in all 30 (100%) aneurysms, with stent assistance in 1 aneurysm and coiling only in 29. Aneurysm sac coiling was done in 25 aneurysms, whereas parent artery occlusion was done in 5 aneurysms. Raymond I occlusion were immediately achieved in 19 of 30 (63.3%) aneurysms. Complications occurred in 1 patient because of aneurysm rupture. Angiographic and clinical follow-up data were obtained from 28 patients. Follow-up angiography (mean, 10.14 ± 5.31 months) revealed Raymond I classification in 22 aneurysms (78.6%). At the end of clinical follow-up (mean, 11.89 ± 5.07 months), clinical monitoring using the MRS showed a score of 0 in 18 patients, score of 1 in 5 patients, score of 2 in 2 patients, score of 3 in 2 patients, and score of 4 in 1 patient. CONCLUSIONS EVT is a feasible and effective therapy to treat ruptured aneurysms located at distal cerebral arteries.
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Affiliation(s)
- Jiang Zhou
- Department of Neurosurgery, The Tenth Affiliated People's Hospital of Shanghai Tong Ji University, Shanghai, China
| | - Yanlong Wang
- Department of Neurosurgery, Ningbo Yinzhou No. 2 Hospital, Ningbo, China
| | - Dongfeng Wang
- Department of Neurosurgery, Ningbo City Medical Treatment Center Lihuili Hospital, Ningbo, China
| | - Qifeng Chen
- Department of Neurosurgery, Ningbo City Medical Treatment Center Lihuili Hospital, Ningbo, China
| | - Hongcai Wang
- Department of Neurosurgery, Ningbo City Medical Treatment Center Lihuili Hospital, Ningbo, China
| | - Liang Gao
- Department of Neurosurgery, The Tenth Affiliated People's Hospital of Shanghai Tong Ji University, Shanghai, China.
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