Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Endovascular Treatment of 429 Anterior Communicating Artery Aneurysms Using Bare-Platinum Coils : Clinical and Radiologic Outcomes at the Long-term Follow-up

  • Lee, Jong Young (Department of Neurosurgery, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Seo, Jeong Hwa (Department of Neurology, Busan Paik Hospital, Inje University College of Medicine) ;
  • Cho, Young Dae (Department of Radiology, Seoul National University College of Medicine) ;
  • Kang, Hyun-Seung (Department of Neurosurgery, Seoul National University College of Medicine) ;
  • Han, Moon Hee (Department of Radiology, Seoul National University College of Medicine)
  • Received : 2014.02.19
  • Accepted : 2014.08.01
  • Published : 2015.03.28
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Abstract

Objective : We reviewed the feasibility, safety and efficacy as well as the clinical outcome and long-term angiographic results of endovascular treatment (EVT) of the anterior communicating artery (ACoA) aneurysms. Methods : A total of 429 ACoA aneurysms in 426 patients were treated using coil embolization between March 1996 and October 2010 in a single institution. Pretreatment aneurysmal features were checked using angiogram. We had usually used tailored steam shaped microcatheter according to individual angiographic architectures. Immediate postembolization outcomes were evaluated using an angiographic outcome scale and clinical evaluation was performed using the Glasgow Outcome Scale (GOS). Results : Postembolization angiograms demonstrated total occlusion of aneurysm in 290 of 429 (67.6%) aneurysms, neck remnant in 80 (18.6%) and body filling in 59 (13.8%). Dome direction and aneurysm angle was not associated with initial angiographic outcomes. The procedure-related morbidity rate was 0.9% (4 of 429). Clinical and imaging follow-up more than 6 months were available in 382 (89.0%) patients with a mean of 26.2 months. Overall rate of major recanalization was 7.9% (30 of 382) and all of them were retreated without complications. At the last follow-up, 233 (99.2%) of 235 patients had GOS of 5 in unruptured group, and 152 (79.5%) of 191 patients showed good clinical outcomes (GOS of 4 or 5) in ruptured group. Conclusion : Tailored steam shaping of the microcatheter is vital to achieve good angiographic outcomes regardless of aneurysmal direction. EVT is feasible and safe for most ACoA aneurysms with acceptable immediate and long-term outcomes.

Keywords

References

  1. Agrawal A, Kato Y, Chen L, Karagiozov K, Yoneda M, Imizu S, et al. : Anterior communicating artery aneurysms : an overview. Minim Invasive Neurosurg 51 : 131-135, 2008 https://doi.org/10.1055/s-2008-1073169
  2. Akyuz M, Erylmaz M, Ozdemir C, Goksu E, Ucar T, Tuncer R : Effect of temporary clipping on frontal lobe functions in patients with ruptured aneurysm of the anterior communicating artery. Acta Neurol Scand 112 : 293-297, 2005 https://doi.org/10.1111/j.1600-0404.2005.00483.x
  3. Birknes JK, Hwang SK, Pandey AS, Cockroft K, Dyer AM, Benitez RP, et al. : Feasibility and limitations of endovascular coil embolization of anterior communicating artery aneurysms : morphological considerations. Neurosurgery 59 : 43-52; discussion 43-52, 2006 https://doi.org/10.1227/01.NEU.0000219220.25721.B9
  4. Brisman JL, Song JK, Newell DW : Cerebral aneurysms. N Engl J Med 355 : 928-939, 2006 https://doi.org/10.1056/NEJMra052760
  5. Chan A, Ho S, Poon WS : Neuropsychological sequelae of patients treated with microsurgical clipping or endovascular embolization for anterior communicating artery aneurysm. Eur Neurol 47 : 37-44, 2002 https://doi.org/10.1159/000047945
  6. Diraz A, Kobayashi S, Toriyama T, Ohsawa M, Hokama M, Kitazama K : Surgical approaches to the anterior communicating artery aneurysm and their results. Neurol Res 15 : 273-280, 1993 https://doi.org/10.1080/01616412.1993.11740148
  7. Elias T, Ogungbo B, Connolly D, Gregson B, Mendelow AD, Gholkar A : Endovascular treatment of anterior communicating artery aneurysms : results of clinical and radiological outcome in Newcastle. Br J Neurosurg 17 : 278-286, 2003 https://doi.org/10.1080/0268869031000153251
  8. Elijovich L, Higashida RT, Lawton MT, Duckwiler G, Giannotta S, Johnston SC, et al. : Predictors and outcomes of intraprocedural rupture in patients treated for ruptured intracranial aneurysms : the CARAT study. Stroke 39 : 1501-1506, 2008 https://doi.org/10.1161/STROKEAHA.107.504670
  9. Fernandez Zubillaga A, Guglielmi G, Viñuela F, Duckwiler GR : Endovascular occlusion of intracranial aneurysms with electrically detachable coils : correlation of aneurysm neck size and treatment results. AJNR Am J Neuroradiol 15 : 815-820, 1994
  10. Finitsis S, Anxionnat R, Lebedinsky A, Albuquerque PC, Clayton MF, Picard L, et al. : Endovascular treatment of ACom intracranial aneurysms. Report on series of 280 patients. Interv Neuroradiol 16 : 7-16, 2010 https://doi.org/10.1177/159101991001600101
  11. Fontanella M, Perozzo P, Ursone R, Garbossa D, Bergui M : Neuropsychological assessment after microsurgical clipping or endovascular treatment for anterior communicating artery aneurysm. Acta Neurochir (Wien) 145 : 867-872; discussion 872, 2003 https://doi.org/10.1007/s00701-003-0111-5
  12. Fujii Y, Takeuchi S, Sasaki O, Minakawa T, Koike T, Tanaka R : Serial changes of hemostasis in aneurysmal subarachnoid hemorrhage with special reference to delayed ischemic neurological deficits. J Neurosurg 86 : 594-602, 1997 https://doi.org/10.3171/jns.1997.86.4.0594
  13. Gonzalez N, Sedrak M, Martin N, Vinuela F : Impact of anatomic features in the endovascular embolization of 181 anterior communicating artery aneurysms. Stroke 39 : 2776-2782, 2008 https://doi.org/10.1161/STROKEAHA.107.505222
  14. Guglielmi G, Viñuela F, Duckwiler G, Jahan R, Cotroneo E, Gigli R : Endovascular treatment of 306 anterior communicating artery aneurysms : overall, perioperative results. J Neurosurg 110 : 874-879, 2009 https://doi.org/10.3171/2008.10.JNS081005
  15. Henkes H, Fischer S, Liebig T, Weber W, Reinartz J, Miloslavski E, et al. : Repeated endovascular coil occlusion in 350 of 2759 intracranial aneurysms : safety and effectiveness aspects. Neurosurgery 58 : 224-232; discussion 224-232, 2006 https://doi.org/10.1227/01.NEU.0000194831.54183.3F
  16. Hernesniemi J, Dashti R, Lehecka M, Niemelä M, Rinne J, Lehto H, et al. : Microneurosurgical management of anterior communicating artery aneurysms. Surg Neurol 70 : 8-28; discussion 29, 2008 https://doi.org/10.1016/j.surneu.2008.01.056
  17. Inagawa T : Multiple intracranial aneurysms in elderly patients. Acta Neurochir (Wien) 106 : 119-126, 1990 https://doi.org/10.1007/BF01809453
  18. Jennett B, Snoek J, Bond MR, Brooks N : Disability after severe head injury : observations on the use of the Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry 44 : 285-293, 1981 https://doi.org/10.1136/jnnp.44.4.285
  19. Kang HS, Han MH, Kwon BJ, Jung C, Kim JE, Kwon OK, et al. : Is clopidogrel premedication useful to reduce thromboembolic events during coil embolization for unruptured intracranial aneurysms? Neurosurgery 67 : 1371-1376; discussion 1376, 2010 https://doi.org/10.1227/NEU.0b013e3181efe3ef
  20. Kang HS, Han MH, Kwon BJ, Kwon OK, Kim SH : Repeat endovascular treatment in post-embolization recurrent intracranial aneurysms. Neurosurgery 58 : 60-70; discussion 60-70, 2006 https://doi.org/10.1227/01.NEU.0000194188.51731.13
  21. Kang HS, Kwon BJ, Kim JE, Han MH : Preinterventional clopidogrel response variability for coil embolization of intracranial aneurysms : clinical implications. AJNR Am J Neuroradiol 31 : 1206-1210, 2010 https://doi.org/10.3174/ajnr.A2051
  22. Kang HS, Kwon BJ, Roh HG, Yoon SW, Chang HW, Kim JE, et al. : Intra-arterial tirofiban infusion for thromboembolism during endovascular treatment of intracranial aneurysms. Neurosurgery 63 : 230-237; discussion 237-238, 2008 https://doi.org/10.1227/01.NEU.0000320440.85178.CC
  23. Kappelle LJ, Eliasziw M, Fox AJ, Barnett HJ : Small, unruptured intracranial aneurysms and management of symptomatic carotid artery stenosis. North American Symptomatic Carotid Endarterectomy Trial Group. Neurology 55 : 307-309, 2000 https://doi.org/10.1212/WNL.55.2.307
  24. Keogh AJ, Sharma RR, Vanner GK : The anterior interhemispheric trephine approach to anterior midline aneurysms : results of treatment in 72 consecutive patients. Br J Neurosurg 7 : 5-12, 1993 https://doi.org/10.3109/02688699308995050
  25. Kwon BJ, Chang HW, Youn SW, Kim JE, Han MH : Intracranial aneurysm perforation during endosaccular coiling : impact on clinical outcome, initial occlusion, and recanalization rates. Neurosurgery 63 : 676-672; discussion 682-683, 2008 https://doi.org/10.1227/01.NEU.0000325500.73330.C2
  26. Kwon BJ, Im SH, Park JC, Cho YD, Kang HS, Kim JE, et al. : Shaping and navigating methods of microcatheters for endovascular treatment of paraclinoid aneurysms. Neurosurgery 67 : 34-40; discussion 40, 2010 https://doi.org/10.1227/01.NEU.0000370891.67129.2F
  27. Mira JM, Costa FA, Horta BL, Fabião OM : Risk of rupture in unruptured anterior communicating artery aneurysms : meta-analysis of natural history studies. Surg Neurol 66 Suppl 3 : S12-S19; discussion S19, 2006 https://doi.org/10.1016/j.surneu.2006.06.025
  28. Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, et al. : International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms : a randomised trial. Lancet 360 : 1267-1274, 2002 https://doi.org/10.1016/S0140-6736(02)11314-6
  29. Molyneux AJ, Kerr RS, Birks J, Ramzi N, Yarnold J, Sneade M, et al. : Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT) : long-term follow-up. Lancet Neurol 8 : 427-433, 2009 https://doi.org/10.1016/S1474-4422(09)70080-8
  30. Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, et al. : International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms : a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366 : 809-817, 2005 https://doi.org/10.1016/S0140-6736(05)67214-5
  31. Moret J, Pierot L, Boulin A, Castaings L, Rey A : Endovascular treatment of anterior communicating artery aneurysms using Guglielmi detachable coils. Neuroradiology 38 : 800-805, 1996 https://doi.org/10.1007/s002340050352
  32. Proust F, Debono B, Hannequin D, Gerardin E, Clavier E, Langlois O, et al. : Treatment of anterior communicating artery aneurysms : complementary aspects of microsurgical and endovascular procedures. J Neurosurg 99 : 3-14, 2003 https://doi.org/10.3171/jns.2003.99.1.0003
  33. Proust F, Martinaud O, Gérardin E, Derrey S, Levèque S, Bioux S, et al. : Quality of life and brain damage after microsurgical clip occlusion or endovascular coil embolization for ruptured anterior communicating artery aneurysms : neuropsychological assessment. J Neurosurg 110 : 19-29, 2009 https://doi.org/10.3171/2008.3.17432
  34. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, et al. : Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34 : 1398-1403, 2003 https://doi.org/10.1161/01.STR.0000073841.88563.E9
  35. Roy D, Milot G, Raymond J : Endovascular treatment of unruptured aneurysms. Stroke 32 : 1998-2004, 2001 https://doi.org/10.1161/hs0901.095600
  36. Schramm J, Cedzich C : Outcome and management of intraoperative aneurysm rupture. Surg Neurol 40 : 26-30, 1993 https://doi.org/10.1016/0090-3019(93)90165-W
  37. Sekhar LN, Natarajan SK, Britz GW, Ghodke B : Microsurgical management of anterior communicating artery aneurysms. Neurosurgery 61 (5 Suppl 2) : 273-290; discussion 290-292, 2007
  38. Sluzewski M, van Rooij WJ : Early rebleeding after coiling of ruptured cerebral aneurysms : incidence, morbidity, and risk factors. AJNR Am J Neuroradiol 26 : 1739-1743, 2005
  39. Tsutsumi K, Ueki K, Morita A, Kirino T : Risk of rupture from incidental cerebral aneurysms. J Neurosurg 93 : 550-553, 2000 https://doi.org/10.3171/jns.2000.93.4.0550
  40. Wiebers DO : Unruptured intracranial aneurysms : natural history and clinical management. Update on the international study of unruptured intracranial aneurysms. Neuroimaging Clin N Am 16 : 383-390, vii, 2006 https://doi.org/10.1016/j.nic.2006.04.005
  41. Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, et al. : Unruptured intracranial aneurysms : natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362 : 103-110, 2003 https://doi.org/10.1016/S0140-6736(03)13860-3
  42. YaSargil MG : Anterior communicating artery aneurysm in YaSargil MG (ed) : Microneurosurgery. New-York : Thieme-Verlag, 1984, Vol II, pp169-223

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