Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Endovascular Treatment of Ruptured Pericallosal Artery Aneurysms

  • Ko, Jun Kyeung (Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital) ;
  • Kim, Hwan Soo (Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital) ;
  • Choi, Hyuk Jin (Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital) ;
  • Lee, Tae Hong (Department of Diagnostic Radiology, Medical Research Institute, Pusan National University Hospital) ;
  • Yun, Eun Young (Department of Biostatistics, Medical Research Institute, Pusan National University Hospital) ;
  • Choi, Chang Hwa (Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital)
  • Received : 2015.01.02
  • Accepted : 2015.04.13
  • Published : 2015.10.28
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Abstract

Objective : Aneurysms arising from the pericallosal artery (PA) are uncommon and challenging to treat. The aim of this study was to report our experiences of the endovascular treatment of ruptured PA aneurysms. Methods : From September 2003 to December 2013, 30 ruptured PA aneurysms in 30 patients were treated at our institution via an endovascular approach. Procedural data, clinical and angiographic results were retrospectively reviewed. Results : Regarding immediate angiographic control, complete occlusion was achieved in 21 (70.0%) patients and near-complete occlusion in 9 (30.0%). Eight procedure-related complications occurred, including intraprocedural rupture and early rebleeding in three each, and thromboembolic event in two. At last follow-up, 18 patients were independent with a modified Rankin Scale (mRS) score of 0-2, and the other 12 were either dependent or had expired (mRS score, 3-6). Adjacent hematoma was found to be associated with an increased risk of poor clinical outcome. Seventeen of 23 surviving patients underwent follow-up conventional angiography (mean, 16.5 months). Results showed stable occlusion in 14 (82.4%), minor recanalization in two (11.8%), and major recanalization, which required recoiling, in one (5.9%). Conclusion : Our experiences demonstrate that endovascular treatment for a ruptured PA aneurysms is both feasible and effective. However, periprocedural rebleedings were found to occur far more often (20.0%) than is generally suspected and to be associated with preoperative contrast retention. Analysis showed existing adjacent hematoma is predictive of a poor clinical outcome.

Keywords

References

  1. Chalif DJ, Weinberg JS : Surgical treatment of aneurysms of the anterior cerebral artery. Neurosurg Clin N Am 9 : 797-821, 1998
  2. Cho YD, Lee JY, Seo JH, Kang HS, Kim JE, Kwon OK, et al. : Early recurrent hemorrhage after coil embolization in ruptured intracranial aneurysms. Neuroradiology 54 : 719-726, 2012 https://doi.org/10.1007/s00234-011-0950-3
  3. de Sousa AA, Dantas FL, de Cardoso GT, Costa BS : Distal anterior cerebral artery aneurysms. Surg Neurol 52 : 128-135; discussion 135-136, 1999 https://doi.org/10.1016/S0090-3019(99)00066-X
  4. Hernesniemi J, Tapaninaho A, Vapalahti M, Niskanen M, Kari A, Luukkonen M : Saccular aneurysms of the distal anterior cerebral artery and its branches. Neurosurgery 31 : 994-998; discussion 998-999, 1992 https://doi.org/10.1227/00006123-199212000-00002
  5. Huang Q, Shen J, Xu Y, Liu J : Endovascular treatment of ruptured distal anterior cerebral artery aneurysm. Neurol India 58 : 259-263, 2010 https://doi.org/10.4103/0028-3886.63809
  6. Jartti P, Isokangas JM, Karttunen A, Jartti A, Haapea M, Koskelainen T, et al. : Early rebleeding after coiling of ruptured intracranial aneurysms. Acta Radiol 51 : 1043-1049, 2010 https://doi.org/10.3109/02841851.2010.508172
  7. Johnston SC, Dowd CF, Higashida RT, Lawton MT, Duckwiler GR, Gress DR, et al. : Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms : the Cerebral Aneurysm Rerupture After Treatment (CARAT) study. Stroke 39 : 120-125, 2008 https://doi.org/10.1161/STROKEAHA.107.495747
  8. Kassell NF, Torner JC : Size of intracranial aneurysms. Neurosurgery 12 : 291-297, 1983 https://doi.org/10.1227/00006123-198303000-00007
  9. Keston P, White PM, Horribine L, Sellar R : The endovascular management of pericallosal artery aneurysms. J Neuroradiol 31 : 384-390, 2004 https://doi.org/10.1016/S0150-9861(04)97021-6
  10. Lee JW, Lee KC, Kim YB, Huh SK : Surgery for distal anterior cerebral artery aneurysms. Surg Neurol 70 : 153-159; discussion 159, 2008 https://doi.org/10.1016/j.surneu.2008.03.012
  11. Lehecka M, Lehto H, Niemela M, Juvela S, Dashti R, Koivisto T, et al. : Distal anterior cerebral artery aneurysms : treatment and outcome analysis of 501 patients. Neurosurgery 62 : 590-601; discussion 590-601, 2008 https://doi.org/10.1227/01.neu.0000317307.16332.03
  12. Martines F, Blundo C, Chiappetta F : Surgical treatment of the distal anterior cerebral artery aneurysms. J Neurosurg Sci 40 : 189-194, 1996
  13. Menovsky T, van Rooij WJ, Sluzewski M, Wijnalda D : Coiling of ruptured pericallosal artery aneurysms. Neurosurgery 50 : 11-14; discussion 14-15, 2002
  14. 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
  15. Nguyen TN, Raymond J, Roy D, Chagnon M, Weill A, Iancu-Gontard D, et al. : Endovascular treatment of pericallosal aneurysms. J Neurosurg 107 : 973-976, 2007 https://doi.org/10.3171/JNS-07/11/0973
  16. Nomura M, Kida S, Uchiyama N, Yamashima T, Yoshikawa J, Yamashita J, et al. : Ruptured irregularly shaped aneurysms : pseudoaneurysm formation in a thrombus located at the rupture site. J Neurosurg 93 : 998-1002, 2000 https://doi.org/10.3171/jns.2000.93.6.0998
  17. Oishi H, Nonaka S, Yamamoto M, Arai H : Feasibility and efficacy of endovascular therapy for ruptured distal anterior cerebral artery aneurysms. Neurol Med Chir (Tokyo) 53 : 304-309, 2013 https://doi.org/10.2176/nmc.53.304
  18. Pandey A, Rosenwasser RH, Veznedaroglu E : Management of distal anterior cerebral artery aneurysms : a single institution retrospective analysis (1997-2005). Neurosurgery 61 : 909-916; discussion 916-917, 2007 https://doi.org/10.1227/01.neu.0000303186.26684.81
  19. Park HS, Kwon SC, Kim MH, Park ES, Sim HB, Lyo IU : Endovascular coil embolization of distal anterior cerebral artery aneurysms : angiographic and clinical follow-up results. Neurointervention 8 : 87-91, 2013 https://doi.org/10.5469/neuroint.2013.8.2.87
  20. Park KY, Kim BM, Lim YC, Chung J, Kim DJ, Joo JY, et al. : The role of endovascular treatment for ruptured distal anterior cerebral artery aneurysms : comparison with microsurgical clipping. J Neuroimaging 25 : 81-86, 2015 https://doi.org/10.1111/jon.12073
  21. Proust F, Toussaint P, Hannequin D, Rabenenoina C, Le Gars D, Freger P : Outcome in 43 patients with distal anterior cerebral artery aneurysms. Stroke 28 : 2405-2409, 1997 https://doi.org/10.1161/01.STR.28.12.2405
  22. 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
  23. Sturiale CL, Brinjikji W, Murad MH, Cloft HJ, Kallmes DF, Lanzino G : Endovascular treatment of distal anterior cerebral artery aneurysms : single-center experience and a systematic review. AJNR Am J Neuroradiol 34 : 2317-2320, 2013 https://doi.org/10.3174/ajnr.A3629
  24. Suzuki S, Kurata A, Yamada M, Iwamoto K, Nakahara K, Sato K, et al. : Outcomes analysis of ruptured distal anterior cerebral artery aneurysms treated by endosaccular embolization and surgical clipping. Interv Neuroradiol 17 : 49-57, 2011 https://doi.org/10.1177/159101991101700108
  25. Waldenberger P, Petersen J, Chemelli A, Schenk C, Gruber I, Strasak A, et al. : Endovascular therapy of distal anterior cerebral artery aneurysms-an effective treatment option. Surg Neurol 70 : 368-377, 2008 https://doi.org/10.1016/j.surneu.2007.07.058
  26. Xavier AR, Abdelbaky A, Rayes M, Tiwari A, Narayanan S : Clinical and angiographic outcome in patients with completely occluded intracranial aneurysms by endovascular coiling : our experience. J Neurointerv Surg 3 : 335-339, 2011 https://doi.org/10.1136/jnis.2010.003889
  27. Yamazaki T, Sonobe M, Kato N, Kasuya H, Ikeda G, Nakamura K, et al. : Endovascular coiling as the first treatment strategy for ruptured pericallosal artery aneurysms : results, complications, and follow up. Neurol Med Chir (Tokyo) 53 : 409-417, 2013 https://doi.org/10.2176/nmc.53.409

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