Bilateral ophthalmic segment "kissing" aneurysms presenting with subarachnoid hemorrhage--case report

Endovascular treatment of "kissing aneurysms" at the anterior communicating artery

Kissing aneurysms are the rare type of multiple aneurysms. They are adjacent aneurysms of different origin arteries in the same region, which require great care in diagnosis and treatment. We report a case of kissing aneurysms at the anterior communicating artery (AcomA) which were treated by endovascular coil embolization.

Endovascular management for bilateral ophthalmic segment "kissing" aneurysms presenting with nasal bleeding. A case report

A rare case of bilateral ophthalmic segment "kissing" aneurysms is reported. A 32-year-old man presented with nasal bleeding and headaches. Cerebral angiography demonstrated bilateral internal carotid-ophthalmic aneurysms. Both aneurysms were treated in the same procedure because of uncertainty over which aneurysm had bled. The left aneurysm was coiled intrasaccularly, the right one was treated by parent artery occlusion. Surgery for kissing aneurysms has been recognized as hazardous and challenging. We emphasize that the endovascular technique described is reasonable.

“Kissing Aneurysms” of the Anterior Communicating Artery Treated With Coil Embolization

PURPOSE

To present a case of kissing aneurysms of the anterior communicating artery treated with endovascular coil embolization and discuss the advantages and disadvantages of this technique compared with neck clipping.

CASE REPORT

A 48-year-old man became drowsy and was admitted to the hospital; he had right hemiparesis and aphasia. Computed tomography revealed diffuse subarachnoid hemorrhage; diagnostic angiography identified an aneurysm at the left A1-A2 junction of the anterior communicating artery and another in the distal anterior cerebral artery (ACA). Endovascular coil embolization was performed on the same day. During the procedure, the 3-mm-diameter junctional aneurysm was successfully packed with coils, but an additional aneurysm was suspected; right carotid angiography following embolization of the left aneurysm clearly showed a mirror image aneurysm of the right A1-A2 junction. The right aneurysm was treated using the same technique. The broad-necked ACA aneurysm was unsuitable for embolization, so neck clipping was performed 5 weeks later. The patient was discharged to his home following complete recovery 7 weeks after the coil embolization.

CONCLUSIONS

Kissing aneurysms are a rare and specific type of multiple aneurysms that require caution in diagnosis and surgical management. Endovascular treatment may be suitable because it does not involve dissection around the aneurysms.