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Coil embolization in precommunicating (A1) segment aneurysms of anterior cerebral artery

  • Interventional Neuroradiology
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Abstract

Introduction

Precommunicating (A1) segment aneurysms of the anterior cerebral artery are rare and often pose technical challenges for coil embolization due to their distinctive configurations. Clinical and radiologic outcomes of treating such aneurysms through endovascular coil embolization are presented herein.

Methods

Data accruing prospectively from May 2002 to August 2013 yielded 48 patients harboring 50 A1 segment aneurysms, each classified as proximal, middle, or distal by location. Clinical outcome of the patients and morphological outcome of the aneurysms were assessed, with emphasis on technical aspects of treatment.

Results

The aneurysms studied occupied either proximal (n = 39), middle (n = 6), or distal (n = 5). Proximal aneurysms were largely directed posteriorly (80 %), and most (97 %) were devoid of branches. Middle and distal aneurysms were associated with the medial lenticulostriate artery, cortical branches, or fenestrations. The preshaped “S” and steam-shaped “S” microcatheters facilitated aneurysm selection in 60 % of lesions. Single-microcatheter technique was most commonly applied for coil embolization (62 %), followed by balloon protection (16 %). Successful aneurysmal occlusion could be achieved in 76 % of the patients, with no procedure-related morbidity and mortality. At final follow-up (mean interval, 29.9 months), stable aneurysmal occlusion was sustained in 93 % of the patients (40/43).

Conclusion

A1 segment aneurysms are amenable to safe and efficacious endovascular coil embolization by adjusting procedural strategy to accommodate distinctive anatomic configurations.

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Acknowledgments

This study was supported by a grant of the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare and Family Affairs, Republic of Korea (A111101).

Conflict of interest

We declare that we have no conflict of interest.

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Correspondence to Hyun-Seung Kang.

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Cho, Y.D., Ahn, J.H., Jung, S.C. et al. Coil embolization in precommunicating (A1) segment aneurysms of anterior cerebral artery. Neuroradiology 56, 219–225 (2014). https://doi.org/10.1007/s00234-014-1319-1

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  • DOI: https://doi.org/10.1007/s00234-014-1319-1

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