Endovascular treatment of distal anterior cerebral artery aneurysms: Technical results and review of the literature

Background We sought to report our technical success and complications in treating distal anterior cerebral artery (ACA) aneurysms with coil embolization. METHODS We retrospectively reviewed all patients undergoing coil embolization of distal ACA aneurysms from September 1999 to March 2008. Patients were assessed for subarachnoid hemorrhage, fundus size, and fundus-to-neck ratio (F/N) < 2 or ≥ 2. Technical success for aneurysms was assessed according to established criteria immediately post-procedure and at 6-month angiographic follow-up. Post-procedural outcomes were measured using the modified Rankin Scale (mRS) at discharge. A mRS ≤ 2 for ruptured aneurysms or no change from baseline for unruptured aneurysms was considered a good clinical outcome. RESULTS Based on an intention-to-treat principle, we attempted embolization of 28 distal ACA aneurysms in 26 patients and were technically successful in 26 aneurysms (93%). Our mean age was 58 ± 11 years. Thirteen presented with acute rupture. Average aneurysm size was 5.7 ± 2.8 mm in our cohort with 20/28 (71%) having an F/N ≥ 2. Seventeen aneurysms with an F/N ≥ 2 and 5 with an F/N < 2 were completely obliterated or had minimal neck remnants at the end of the procedure (79%). Fourteen aneurysms underwent 6-month angiographic follow-up and were either completely obliterated or had a minimal residual neck remnant. Clinical outcomes were good in 12/13 unruptured patients (93%) at the time of discharge and in 6/13 ruptured patients (46%) with 90-day follow-up. Three patients had ischemic complications that were considered non-disabling, and 2 patients died from complications related to their initial subarachnoid hemorrhage. Two patients had an aborted procedure from failure to catheterize the aneurysm. Conclusion Endovascular treatment of distal ACA aneurysms can achieve good technical and clinical outcomes.