Endovascular therapy of distal anterior cerebral artery aneurysms-an effective treatment option.
BACKGROUND
Surgical treatment of APAs is associated with relatively high morbidity and mortality. The aim of this study was to illustrate the technical achievements of endovascular procedures in the distal anterior cerebral artery area, technical difficulties and how they can be overcome, and the outcome of endovascular treatment of APAs.


METHODS
Between 1997 and 2006, of 49 patients with APAs at our institution, 29 were treated endovascularly (4.1% of all endovascularly treated aneurysms; F:M = 3.8; mean age, 52.8 +/- 11.5 years), and 12 were treated surgically. Twenty-one (72.4%) of the endovascularly treated patients had a subarachnoid hemorrhage. The mean observation period was 25 +/- 22.8 months.


RESULTS
In 27 (93.1%) cases, complete occlusion of the aneurysm was achieved. The intervention led to 5 (17.2%) cases of minor complications with no neurologic deficits: 2 thromboembolisms, 1 local thrombus, 1 occlusion, and 1 recurrent hemorrhage. Mortality related to the intervention was 3.4%. There was no morbidity associated with the elective procedures. The dome-to-neck ratio is the main predictor of reperfusion. The most important factor impairing the outcome in terms of the GOS status is the presence of an intraparenchymal hematoma, followed by thrombembolic complications.


CONCLUSIONS
Endovascular treatment of APAs is feasible, safe, and effective. Mortality and morbidity are comparable with surgical therapy. An intraparenchymal hematoma has a severe negative influence on the patient's condition after rehabilitation. In these cases, surgical intervention should be considered. In case of incomplete occlusion of the aneurysm, prompt reintervention is required.
Waldenberger
Peter
P
Department of Radiology, Innsbruck Medical University, Innsbruck 6020, Austria.
Petersen
Johannes
J
Chemelli
Andreas
A
Schenk
Claudia
C
Gruber
Ingrid
I
Strasak
Alexander
A
Eisner
Wilhelm
W
Beer
Ronny
R
Glodny
Bernhard
B
D000328:Adult; D000368:Aged; D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D003337:Corpus Callosum / Q000098:blood supply; D004621:Embolization, Therapeutic; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006179:Gyrus Cinguli / Q000098:blood supply; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy; D016896:Treatment Outcome