Distal aneurysms of the unpaired ACA: embryologic and therapeutic aspects

Anatomical variants of the cerebral arteries in general are frequent and due to the complex ontogenesis of these structures. Although encountered in many mammals, a single anterior cerebral artery (ACA) trunk is an infrequent finding in humans with an incidence of 3-5%. This vessel, giving rise to the arteries of both frontal lobes, is subjected to high flow volumes and distal arterial aneurysms have repetitively been encountered, mostly however before the introduction of endovascular treatment strategies. We report on five patients with acute SAH and arterial aneurysms of an unpaired ACA, who underwent coil embolisation. In all cases endovascular treatment using detachable platinum coils resulted in an at least satisfactory degree of aneurysm obliteration without parent artery occlusion or embolic infarcts. All patients had clinical and angiographic follow-up with median follow-up time of 29 months during which no aneurysm regrowth was encountered. In spite of a small patient group our results suggest, that altered flow dynamics due to enlarged single intracranial vessels may predispose to aneurysm formation and that endovascular embolisation is an appropriate treatment option in distal aneurysms of an unpaired ACA.