Key result
Endovascular coil placement for distal ACA aneurysms achieved complete occlusion in 50% and near-complete occlusion in 45% of cases, with no procedural deaths.
Why the study?
Does endovascular coil placement safely and effectively treat distal ACA aneurysms?
Observational (n=22)
No
Does endovascular coil placement safely and effectively treat distal ACA aneurysms?
Endovascular coil placement is a safe and effective treatment for distal ACA aneurysms, achieving high rates of complete or near-complete occlusion with low morbidity.
Hypothesis-generating for distal ACA aneurysms; prospective trials needed before practice change.
BACKGROUND AND PURPOSE: Distal ACA aneurysms remain difficult to treat with endovascular therapy, but improved technology and experience allows for the treatment of some of these aneurysms with excellent results. The purpose of this study was to assess the status of endovascular treatment of distal ACA aneurysms by comparing our results with recent endovascular and microsurgical series of distal ACA aneurysms. MATERIALS AND METHODS: Between 2000 and 2008, a total of 22 consecutive patients (14 women; mean age, 58.4 years) with distal ACA aneurysms underwent coil placement at Barrow Neurological Institute. Clinical presentations, radiographic findings, endovascular management, and outcomes were reviewed retrospectively. RESULTS: Of the 22 patients, 13 (59%) presented with subarachnoid hemorrhage. Six patients were HH grade I or II, 1 was grade III, 5 were grade IV, and 1 was grade V. Frontal lobe hematomas occurred in 5 patients with ruptured aneurysms. The mean aneurysm size was 7.5 mm (range, 2.8-25 mm); 55% were smaller than 7 mm. Twelve aneurysms (55%) arose from the origin of the callosomarginal artery (55%). Complete occlusion was achieved in 50% of the cases and near-complete occlusion in 45%. The few periprocedural complications included 1 retroperitoneal hematoma and 1 intraoperative rupture. Four patients had thromboembolic events adequately treated intraprocedurally with abciximab. No deaths occurred in the patients treated. CONCLUSIONS: The characteristics of the patients and aneurysms treated in our series were comparable to previous reports of endovascular treatment of ACA aneurysms with respect to rupture status. Periprocedural morbidity and mortality rates in our series fared well compared with previous reports, as did our combined rate of complete or near-complete occlusions. Recent advances in endovascular devices and techniques have improved outcomes of distal ACA aneurysms.
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Cavalcanti et al. (2013) conducted an observational in Distal ACA aneurysms (n=22). Endovascular coil placement was evaluated on Complete aneurysm occlusion. Endovascular coil placement for distal ACA aneurysms achieved complete occlusion in 50% and near-complete occlusion in 45% of cases, with no procedural deaths.
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