Unruptured non-branching site aneurysms located on the anterior (dorsal) wall of the supraclinoid internal carotid artery: aneurysmal characteristics and outcomes following endovascular treatment.
BACKGROUND
This study was undertaken to evaluate the aneurysmal characteristics and clinico-radiological outcomes of unruptured non-branching site aneurysms located on the anterior (dorsal) wall of the supraclinoid internal carotid artery (ICA).


METHODS
The data of 34 patients that underwent endovascular treatment for 36 unruptured ICA anterior wall aneurysms were reviewed. ICA anterior wall aneurysms were defined as aneurysms that projected superiorly from the anterior wall of the ICA ophthalmic (n = 35) or communicating (n = 1) segment on lateral angiograms, without any branch vessel relationship. In addition, aneurysmal characteristics and treatment outcomes were compared with those of 60 unruptured aneurysms originating from the posterior (ventral) wall of the ICA ophthalmic segment.


RESULTS
Patients with an ICA anterior wall aneurysm frequently had a mirror aneurysm on the contralateral side (14.7 % versus 3.3 %) or another ICA aneurysm (35.3 % versus 15 %). Two of the 36 ICA anterior wall aneurysms exhibited ICA narrowing suggestive of dissection, and another five had dysplastic ICA dilatation around the neck. Stent-assisted embolization was more frequently performed for ICA anterior wall aneurysms (66.7 % versus 36.7 %) because of unfavorable dome/neck (mean, 1.21) and aspect (mean, 1.15) ratios, and because of microcatheter instability associated with superior aneurysmal projections against the abrupt curvature of the carotid siphon. Procedure-related thromboembolic complications occurred in three patients in the anterior aneurysm group, but no patient deteriorated clinically. Immediate radiological outcomes were more unfavorable for ICA anterior wall aneurysms (residual sac, 36.1 % versus 16.7 %). Nevertheless, rates of recanalization (2.9 % versus 5.2 %) and progressive occlusion (24.7 % versus 8.1 %) during follow-up slightly favored ICA anterior wall aneurysms. Two stent-treated ICA anterior wall aneurysms developed asymptomatic ICA steno-occlusion (8.3 %).


CONCLUSIONS
Stent-assisted embolization is safe and effective for the treatment of unruptured ICA anterior wall aneurysms exhibiting unfavorable aneurysmal geometries and projections for coil embolization.
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Dong, Gangnam-Gu, Seoul, Republic of Korea.
Je Young
JY
Yeon
Seung-Chyul
SC
Hong
Jong-Soo
JS
Kim
Keon Ha
KH
Kim
Pyoung
P
Jeon
D000328:Adult; D000368:Aged; D000783:Aneurysm / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000473:pathology*; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome