Endovascular treatment of anterior choroidal artery aneurysms

Ischemic stroke is the most common complication after surgical clipping of anterior choroidal artery (AChA) aneurysms, and the reported morbidity-mortality rates vary from 5% to 50%. We report the findings in a series of 18 consecutive patients who underwent endovascular treatment (EVT) for an AChA berry aneurysm.

In this retrospective study, the aneurysms were defined according to their size and position, the presence of a concomitant arteriovenous malformation (AVM), the mode of presentation. The patients were clinically assessed before and after the EVT, as well as at each angiographic follow-up.

All were small-sized aneurysms, with greater diameters ranging from 2 to 8 mm (mean, 4 mm), arising from the supraclinoid internal carotid artery close to the origin of the AChA. Two were AVM-associated aneurysms. Fourteen patients (14/18 [78%]) presented with subarachnoid hemorrhage. All aneurysms were selectively embolized with coils. There was one (1/18 [5.5%]) treatment-related death due to aneurysm perforation. Another patient (1/18 [5.5%]) developed a transient controlateral hemiparesis. Fourteen patients (14/18 [78%]) were followed up clinically and angiographically for 3-32 months (mean, 14 months). None of them (re)hemorrhaged during this period.

The EVT of AChA berry aneurysms is effective to protect from rebleeding. Our complication rate compares favorably with those of the surgical series.