H-J Kwon1, Y D Cho2, J W Lim1, H-S Koh1, D H Yoo3, H-S Kang4, M H Han3. 1. From the Department of Neurosurgery (H.-J.K., J.W.L., H.-S. Koh), Regional Cerebrovascular Center, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea. 2. Departments of Radiology (Y.D.C., D.H.Y., M.H.H.) aronnn@naver.com. 3. Departments of Radiology (Y.D.C., D.H.Y., M.H.H.). 4. Neurosurgery (H.-S. Kang), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Abstract
BACKGROUND AND PURPOSE: Aneurysms arising from the proximal A1 segment of the anterior cerebral artery are rare, and their distinctive configurations often pose technical challenges during endovascular embolization. Herein, we present 11 patients with proximal A1 aneurysms requiring a contralateral approach (via the anterior communicating artery) to coil embolization. MATERIALS AND METHODS: From a prospectively collected data repository, we retrieved records of 11 patients consecutively treated for proximal A1 aneurysms between January 2011 and March 2018. In each instance, coil embolization was performed by the contralateral route. Outcomes were analyzed in terms of morphologic features and clinical status. RESULTS: Aneurysms in all 11 patients were directed posteriorly and were small (<5 mm). A contralateral approach (via the anterior communicating artery) was used after ipsilateral attempts at aneurysm selection failed in each instance, despite using a variety of microcatheters. Single punctures and single guiding catheters sufficed in 9 patients, but 2 patients required dual punctures and 2 guiding catheters. All endovascular treatments ultimately yielded excellent outcomes. Although 1 symptomatic infarct was manifested in the course of ipsilateral treatment, no morbidity or mortality resulted from the contralateral access. CONCLUSIONS: Due to angio-anatomic constraints, a contralateral strategy for coil embolization of proximal A1 aneurysms is acceptable if ipsilateral access is technically prohibitive and the vessels (contralateral A1 and anterior communicating artery) are amenable to the passage of microdevices.
BACKGROUND AND PURPOSE:Aneurysms arising from the proximal A1 segment of the anterior cerebral artery are rare, and their distinctive configurations often pose technical challenges during endovascular embolization. Herein, we present 11 patients with proximal A1 aneurysms requiring a contralateral approach (via the anterior communicating artery) to coil embolization. MATERIALS AND METHODS: From a prospectively collected data repository, we retrieved records of 11 patients consecutively treated for proximal A1 aneurysms between January 2011 and March 2018. In each instance, coil embolization was performed by the contralateral route. Outcomes were analyzed in terms of morphologic features and clinical status. RESULTS:Aneurysms in all 11 patients were directed posteriorly and were small (<5 mm). A contralateral approach (via the anterior communicating artery) was used after ipsilateral attempts at aneurysm selection failed in each instance, despite using a variety of microcatheters. Single punctures and single guiding catheters sufficed in 9 patients, but 2 patients required dual punctures and 2 guiding catheters. All endovascular treatments ultimately yielded excellent outcomes. Although 1 symptomatic infarct was manifested in the course of ipsilateral treatment, no morbidity or mortality resulted from the contralateral access. CONCLUSIONS: Due to angio-anatomic constraints, a contralateral strategy for coil embolization of proximal A1 aneurysms is acceptable if ipsilateral access is technically prohibitive and the vessels (contralateral A1 and anterior communicating artery) are amenable to the passage of microdevices.
Authors: G L Pride; B Welch; R Novakovic; K Rickert; J White; K Dutton-Johnson; D Samson; P Purdy Journal: J Neurointerv Surg Date: 2009-10-05 Impact factor: 5.836
Authors: Michael E Kelly; Raymond Turner; Vivek Gonugunta; Henry H Woo; Peter A Rasmussen; Thomas J Masaryk; David Fiorella Journal: Neurosurgery Date: 2007-11 Impact factor: 4.654
Authors: Reza Dashti; Juha Hernesniemi; Hanna Lehto; Mika Niemelä; Martin Lehecka; Jaakko Rinne; Matti Porras; Antti Ronkainen; Surachest Phornsuwannapha; Timo Koivisto; Juha E Jääskeläinen Journal: Surg Neurol Date: 2007-10