Morphological and Technical Factors Associated with Complications and Recanalization of Pericallosal Artery Aneurysms after Endovascular Treatment
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 2
Abstract
We present a series of 31 patients who underwent endovascular treatment due to a pericallosal artery aneurysm. To our knowledge, this is the largest series of patients with pericallosal aneurysms treated by endovascular approach reported so far. The distal location and generally small size of these aneurysms both make them difficult for surgical and endovascular treatment. Our aim was to try to define the risk factors for recanalization and complications of treatment. Various factors were analyzed, such as the patient’s age, occurrence of subarachnoid hemorrhage, aneurysm size, morphology/neck width and side of the aneurysm, incorporation of arterial branches, dominant ipsilateral A1 segment and other anatomic variations, presence of other aneurysms, type of coils used for treatment, the need for stent implantation and the initial degree of occlusion. Our rate of complications of 9.7% and recanalization of 16% were relatively high compared to other aneurysm sites. Relatively large aneurysms and those which incorporated branches were more prone to recanalization. Pericallosal aneurysms in our study were however very morphologically and anatomically heterogeneous, making our sample size insufficient to show the impact of these factors on complications. Distally located intracranial aneurysms are generally rare; the most commonly encountered are aneurysms at the junction of pericallosal and callosomarginal artery. They are usually referred to as pericallosal artery aneurysms (PAAs), or distal anterior cerebral artery (ACA) aneurysms. Neurosurgical approach in this location is difficult because of the proximity to falx [1] and typically small diameter of aneurysms at this site [2], with higher complication rate than in other aneurysm sites [3-6], although there are reports of unfavourable course even in proximal ACA aneurysms [7]. Distal ACA aneurysms may require complex treatment techniques [8]. Endovascular treatment is also complicated by distal location which impedes the manipulation of the micro catheter. Tortuosity of arteries proximal to the aneurysm, especially the angle at the origin of A1 segment of ACA and carotid siphon, further impedes the passage of the micro catheter and micro guide wire, sometimes with a necessary use of force during micro catheterization. This may result in an abrupt entrance into the small aneurysm, which may result in rupture. PAAs typically have a funnel-shaped neck which is difficult for embolization without compromising the flow in the callosomarginal artery origin. Neck remnant after coiling poses the risk for recanalization/re growth of the aneurysm. Small lumen of ACA may even be obstructed by the micro catheter, so that we may be unable to visualize the aneurysm and anatomic landmarks at the neck at the moment of coiling. All these factors have been reported, with a relatively high rate of complications in endovascular management and high rate of recanalization [9-13]. To our knowledge, we present the largest series of 31 patients so far reported in the literature. We aimed to add to the present knowledge of endovascular treatment of PAAs and to define the risk factors for complications and aneurysm recanalization in this location. Methods: This is a single-center retrospective study of 31 patients who have undergone endovascular repair of a pericallosal artery aneurysm, between 2005 and 2015. Endovascular procedures were performed on a single-plane digital angiography system (Axiom Artis FA; Siemens AG, Erlangen, Germany) with patients in general anesthesia. The patients with unruptured aneurysms received iv. heparin in a dose of 50 IU/kg; no heparin was administered in those with ruptured aneurysms. The follow-up was routinely performed 3 months after the treatment by 3D time-of-flight magnetic resonance angiography, and 6-12 months after the treatment by digital subtraction angiography (DSA).
Authors and Affiliations
Goran Pavlisa
Keywords
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- EP ID EP567195
- DOI 10.26717/BJSTR.2017.01.000196
- Views 129
- Downloads 0
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