Endovascular treatment for cerebral perforating artery aneurysms

Cerebral perforating artery (CPA) aneurysms are rarely reported in the literature, making management decisions challenging. This study is to report neurological outcomes in a single institution experience of perforating artery aneurysms treated endovascularly.

All cases involving patients with CPA aneurysms who presented to Beijing Tiantan Hospital between September 2006 and September 2009 were reviewed retrospectively.

Over 3 years, four patients with four CPA aneurysms were treated. The Hunt and Hess grade on admission ranged from 0 to IV, with intracranial hemorrhage in three of the four patients. Conventional angiography confirmed the presence of the aneurysms, and all patients underwent endovascular embolization using liquid embolic materials with parent artery sacrifice. Associated risk factor in our series of patients was brain arteriovenous malformation. The locations of aneurysm were lenticulostriate artery, anterior choroidal artery and medial posterior choroidal artery. The mean size of the aneurysms was 2.5 mm. The mean modified Rankin scale score at follow-up was 1.25. Three patients in whom the perforating artery was sacrificed had good outcomes, suggesting that loss of the artery is clinically well tolerated.

This case series reveals that endovascular treatment of CPA aneurysms may be an appropriate, effective, and safe therapy.