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Endovascular parent artery occlusion for the treatment of wide-neck A1 segment aneurysms: a single-center experience
E Tollard1, L Niemtschik, T E Darsaut
1Department of Neuroradiology, Centre Hospitalier de l' Universite de Montreal, Montreal, Canada. eleonore.tollard@chu-rouen.fr
Insights
Parent artery occlusion is a feasible and effective treatment for wide-necked A1 aneurysms in patients with good collateral circulation. This endovascular technique demonstrated success in preventing aneurysm rupture with minimal complications.
Area of Science:
- Neurosurgery
- Endovascular Therapy
- Cerebrovascular Disease
Background:
- Wide-necked aneurysms in the A1 segment of the anterior cerebral artery pose treatment challenges.
- Adequate collateral circulation is crucial for parent artery occlusion strategies.
Observation:
- A retrospective study evaluated 9 patients with wide-necked A1 aneurysms treated with coiling and parent artery occlusion.
- Patients had bilateral patent A1 segments and a patent anterior communicating artery (AcomA).
- No acute subarachnoid hemorrhage cases were included.
Findings:
- The procedure was effective in treating wide-necked A1 aneurysms, with no ruptures during follow-up.
- Minor complications included three small infarcts, one symptomatic.
- Recanalization occurred in 3 cases, with 2 showing stable recurrence.
Implications:
- Parent artery occlusion is a viable endovascular option for select wide-necked A1 aneurysms.
- Careful patient selection based on collateral supply is essential for successful outcomes.
- This technique offers an alternative to surgical clipping for specific anterior circulation aneurysms.
Abstract:
The goal of this study was to evaluate the feasibility and efficacy of A1 occlusion at the level of wide necked A1 aneurysms, where there are bilateral patent A1 segments and a patent AcomA. Between 2000 and 2010, 9 patients with wide necked A1 aneurysms were treated by coiling of the aneurysm along with parent vessel occlusion. All aneurysms had a wide neck (≥ 4 mm). None were treated in the acute phase of a subarachnoid hemorrhage. Three small infarcts were noted on routine post-treatment head CT, 1 of which was symptomatic (transient hemiparesthesia). On control angiogram at 6 months or more, 3 A1 recanalizations were found, 2 of which had a stable small neck recurrence. None of the aneurysms ruptured on follow-up. In this series, parent artery occlusion was effective in treating wide-necked aneurysms arising from the A1 segment in patients with adequate collateral supply.
