Embolization for the treatment of unilateral A1 segment anterior communicating artery aneurysm: a report of 48 cases

Objective To summarize the experience and method of endovascular treatment of unilateral A1 segment anterior communicating artery aneurysm with detachable coils.Methods Forty-eight patients with unilateral A1 anterior communicating artery aneurysm(23 males and 25 females,age ranged from 32 to 72 years with mean of 53.4,hospitalized in Xijing hospital from Jan.2009 to Apr.2010) were involved in present study.All of the aneurysms were measured with rotational digital subtraction angiography(RDSA) and image post-processing techniques,and they were embolized with Guglielmi detachable coils(GDCs).The patency of the parent arteries was monitored by catheterization in both carotid arteries in the process of treatment.Stent-assisted,balloon remodeling,microcatheter and microwire assisted techniques were used in the treatment of wide-necked aneurysm to keep patency of parent arteries.Cerebral angiography was performed in 38 cases 6 months after the operation to observe the patency of embolized aneurysms and anterior communicating arteries.Results Of the 48 cases,total occlusion was achieved in 39(81.3%),more than 90% occlusion was achieved in 6(12.5%),and 3(6.3%) with less than 90% occlusion;1 had hemorrhage during embolization,3 had anterior communicating artery occlusion,and 2 had contralateral internal carotid artery compensation after anterior communicating artery occlusion.No re-bleeding was found during the 6 months follow-up period.Cerebral angiography showed total occlusion of aneurysms and patency of anterior communicating arteries in 38 cases during re-examination.Conclusion The anterior communicating arteries should be kept patent in embolization treatment of the major unilateral blood supply anterior communicating artery aneurysms,and it is helpful to use microcatheter or microwire assisted techniques.