Coil embolization in precommunicating (A1) segment aneurysms of anterior cerebral artery.
BACKGROUND
Precommunicating (A1) segment aneurysms of the anterior cerebral artery are rare and often pose technical challenges for coil embolization due to their distinctive configurations. Clinical and radiologic outcomes of treating such aneurysms through endovascular coil embolization are presented herein.


METHODS
Data accruing prospectively from May 2002 to August 2013 yielded 48 patients harboring 50 A1 segment aneurysms, each classified as proximal, middle, or distal by location. Clinical outcome of the patients and morphological outcome of the aneurysms were assessed, with emphasis on technical aspects of treatment.


RESULTS
The aneurysms studied occupied either proximal (n = 39), middle (n = 6), or distal (n = 5). Proximal aneurysms were largely directed posteriorly (80 %), and most (97 %) were devoid of branches. Middle and distal aneurysms were associated with the medial lenticulostriate artery, cortical branches, or fenestrations. The preshaped "S" and steam-shaped "S" microcatheters facilitated aneurysm selection in 60 % of lesions. Single-microcatheter technique was most commonly applied for coil embolization (62 %), followed by balloon protection (16 %). Successful aneurysmal occlusion could be achieved in 76 % of the patients, with no procedure-related morbidity and mortality. At final follow-up (mean interval, 29.9 months), stable aneurysmal occlusion was sustained in 93 % of the patients (40/43).


CONCLUSIONS
A1 segment aneurysms are amenable to safe and efficacious endovascular coil embolization by adjusting procedural strategy to accommodate distinctive anatomic configurations.
Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
Young Dae
YD
Cho
Jun Hyong
JH
Ahn
Seung Chai
SC
Jung
Chang Hun
CH
Kim
Hyun-Seung
HS
Kang
Jeong Eun
JE
Kim
Young Je
YJ
Son
Moon Hee
MH
Han
D002533:Cerebral Angiography / Q000379:methods*; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D061185:Mechanical Thrombolysis / Q000295:instrumentation* / Q000379:methods; D008875:Middle Aged; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome