title: Treatment of complex ruptured anterior communicating arterial aneurysms by endovascular coil embolisation of the anterior communicating artery.
abstract: OBJECTIVE
  The current study evaluates the feasibility and safety of coil embolisation of the anterior communicating artery (ACoA) for the treatment of complicated anterior communicating arterial aneurysms (ACoAAs).
  
  
  METHODS
  Five patients presented with a subarachnoid haemorrhage caused by a ruptured ACoAA. The ACoAA morphologies were well defined by three-dimensional digital subtraction angiography (3D-DSA) and magnetic resonance angiography (MRA). Two of the ACoAAs were tiny (<3 mm in diameter), and the remaining three ACoAAs were small (3-5 mm in diameter). All of the aneurysms were localised to the ACoA. The projection of the aneurysm dome was defined as being oriented superiorly or posteriorly in all five aneurysms. We performed a superselective catheterisation of each aneurysm, and we subsequently performed coil embolisation with balloon, stent or microcatheter assistance. Angiography and clinical follow-up occurred 3-6 months after the procedure. Clinical follow-up data were collected and retrospectively analysed, and patient responses were categorised as fully recovered, improved, unchanged or aggravated.
  
  
  RESULTS
  All five patients with ACoAA were treated successfully using coil embolisation. In three patients, both the aneurysm sac and the ACoA were embolised using coils, and in two patients, only the ACoA was embolised. Acute angiography showed occlusion of the aneurysm and ACoA. Follow-up angiography confirmed complete occlusion of the aneurysm sac, and no ACoAA recurrence was detected in any of the patients. In clinical follow-up visits, none of the patients had haemorrhaged or had a stroke.
  
  
  CONCLUSIONS
  Combined coil embolism of the aneurysm sac and the ACoA could be a feasible and safe method for the treatment of complicated ACoAAs without bilateral aplasia of the A1 segment.
authors.affiliation: Department of Radiology, Shanghai East Hospital, Affiliated Tong Ji University, Shanghai, China.
authors.forename: Chun
authors.initials: C
authors.lastname: Fang
authors.forename: Ming-Hua
authors.initials: MH
authors.lastname: Li
authors.forename: Yue-Qi
authors.initials: YQ
authors.lastname: Zhu
authors.forename: Hua-Qiao
authors.initials: HQ
authors.lastname: Tan
authors.forename: Pei-Lei
authors.initials: PL
authors.lastname: Zhang
authors.forename: Jue
authors.initials: J
authors.lastname: Wang
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000628:therapy*; D015901:Angiography, Digital Subtraction; D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology; D002404:Catheterization / Q000379:methods; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome