Shakir Husain1, Yovita Andhitara2, Somnath Prasad Jena3, Jorge Padilla4, Sahat Aritonang5, Igor Letsoin6. 1. Department of Interventional Neurology and Stroke, Institute of Neurosciences, Max Super-Specialty Hospital, Saket, New Delhi, India; Interventional Neurology and Stroke Fellowship Program, Neo Hospital, Noida, India. Electronic address: consult.drshakir@gmail.com. 2. Department of Neurology, Dr. Kariadi General Hospital/Faculty of Medicine, Diponegoro University, Semarang, Indonesia. 3. Interventional Neurology and Stroke, Stroke and Neurointervention Foundation, Max Super-Specialty Hospital, Saket, New Delhi, India. 4. Neurology, Cotabato Regional and Medical Center, Cotabato City, Philippines. 5. Department of Neurology, Tangerang General Hospital Indonesia, Interventional Neurology and Stroke, Saket City Hospital, New Delhi, India. 6. Department of Neurology, Jayapura General Hospital/Cendrawasih University, Jayapura, Indonesia.
Abstract
OBJECTIVE: Distal anterior cerebral artery (DACA) aneurysms are rare, and their treatment by either surgical clipping or endovascular treatment poses technical difficulties. Earlier studies have reported higher complication rates in DACA aneurysms compared with other aneurysms in the circle of Willis. Therefore, endovascular management of DACA aneurysms still remains a challenge. The aim of this report is to review clinical presentation, angiographic presentation of DACA aneurysms, complications, and outcome of their endovascular treatment in our institutional experience. METHODS: A retrospective review of 186 patients with intracranial aneurysms treated with endovascular management from September 2009 to December 2013 in the Max Superspecialty Hospital, New Delhi, India, 11 patients (5.9%) with 12 DACA aneurysms were studied retrospectively. We report the clinical presentations, cerebral angiographic findings, endovascular treatment, complications, and outcomes. The clinical and angiographic outcomes were assessed using modified Rankin scales and the Raymond scale, respectively. RESULTS: Of 11 patients, 54.5% were female and 45.5% were male; the mean age was 48.4 years (range, 33-65 years). All patients had subarachnoid hemorrhage that indicated ruptured DACA aneurysm. All the DACA aneurysms were small. Postcoiling angiograms showed complete occlusion in 9 patients. Two patients had intraprocedural aneurysm rupture but without any clinical sequelae, and 1 patient had thrombus formation, which was thrombolysed at the end of coiling. All patients had good outcomes. CONCLUSIONS: Our experience with 11 patients showed that endovascular management of small DACA aneurysms, though associated with higher intraprocedural events, is associated with good outcome.
OBJECTIVE: Distal anterior cerebral artery (DACA) aneurysms are rare, and their treatment by either surgical clipping or endovascular treatment poses technical difficulties. Earlier studies have reported higher complication rates in DACA aneurysms compared with other aneurysms in the circle of Willis. Therefore, endovascular management of DACA aneurysms still remains a challenge. The aim of this report is to review clinical presentation, angiographic presentation of DACA aneurysms, complications, and outcome of their endovascular treatment in our institutional experience. METHODS: A retrospective review of 186 patients with intracranial aneurysms treated with endovascular management from September 2009 to December 2013 in the Max Superspecialty Hospital, New Delhi, India, 11 patients (5.9%) with 12 DACA aneurysms were studied retrospectively. We report the clinical presentations, cerebral angiographic findings, endovascular treatment, complications, and outcomes. The clinical and angiographic outcomes were assessed using modified Rankin scales and the Raymond scale, respectively. RESULTS: Of 11 patients, 54.5% were female and 45.5% were male; the mean age was 48.4 years (range, 33-65 years). All patients had subarachnoid hemorrhage that indicated ruptured DACA aneurysm. All the DACA aneurysms were small. Postcoiling angiograms showed complete occlusion in 9 patients. Two patients had intraprocedural aneurysm rupture but without any clinical sequelae, and 1 patient had thrombus formation, which was thrombolysed at the end of coiling. All patients had good outcomes. CONCLUSIONS: Our experience with 11 patients showed that endovascular management of small DACA aneurysms, though associated with higher intraprocedural events, is associated with good outcome.