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The Efficacy of Simultaneous Bilateral Internal Carotid Angiography during Coil Embolization for Anterior
Soon Chan Kwon1, Jun Bum Park, Shang Hun Shin
1Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
Insights
Simultaneous bilateral carotid angiography improved visualization and understanding of complex anterior communicating artery aneurysms. This technique led to more effective and safer coil embolization procedures.
Area of Science:
- Neurosurgery
- Interventional Radiology
- Vascular Neurology
Background:
- Anterior communicating artery (A-com) aneurysms present complex anatomical challenges for coil embolization.
- Optimal visualization of the Hesselbach's complex is crucial for successful treatment.
- Bilateral carotid angiography may enhance anatomical understanding and visualization.
Purpose of the Study:
- To assess the efficacy of simultaneous bilateral internal carotid angiography during coil embolization for A-com artery aneurysms.
- To determine if this technique improves anatomical understanding and procedural outcomes.
Main Methods:
- Retrospective evaluation of 12 patients with A-com artery aneurysms treated with bilateral carotid angiography.
- Angiographic assessment immediately and 6 months post-embolization using a 3-point scale.
- Evaluation of safety, performance, and efficacy of the bilateral angiography approach.
Main Results:
- Bilateral angiography provided superior anatomical detail and understanding of the A-com artery region.
- Complex cases benefited from bilateral routes, leading to more effective coil embolization.
- 92% (11/12) of aneurysms were occluded immediately post-procedure, with no recanalization at 6 months.
Conclusions:
- Simultaneous bilateral carotid angiography enhances anatomical understanding for complex A-com artery aneurysms.
- This approach results in more effective and safer coil embolization compared to unilateral angiography.
- The technique is beneficial for selected complex A-com artery aneurysm cases.
Objective:
Successful coil embolization of anterior communicating (A-com) artery aneurysms requires good visualization and understanding of the entire H complex. Bilateral carotid angiography may optimize anatomical understanding and visualization of the H complex. We therefore assessed the efficacy of simultaneous bilateral internal carotid angiography during coil embolization for A-com artery aneurysms.
Methods:
Of the 153 patients with intracranial saccular aneurysms who underwent embolization between July 2008 and December 2009, 12 had A-com artery aneurysms and were embolized under bilateral carotid angiography. Patients were evaluated angiographically, immediately and 6 months (n=11) after embolization, using a 3-point scale (complete, residual neck, residual aneurysm). The safety, performance and efficacy of this approach were retrospectively evaluated.
Results:
In all patients, bilateral internal carotid artery angiography provided more detailed anatomical information and understanding around the A-com artery, and, in complex situations, it allowed for more effective coil embolization through bilateral routes to the A-com artery. Angiography immediately after embolization showed occlusion of 11 of the 12 (92%) aneurysms, with none of these 11 showing evidence of recanalization at 6 months.
Conclusion:
These findings indicate that simultaneous bilateral carotid angiography during coil embolization of selected complex A-com artery aneurysms provided improved anatomical understanding, and resulted in more effective and safer procedures than typical unilateral angiography.
