Endovascular treatment of distal cerebral aneurysms

Distal cerebral aneurysms are difficult to treat. Endovascular treatment (EVT) although challenging, in many cases allows sparing of the parent artery. If a deconstructive approach is necessary, EVT enables hyperselective catheterization with sacrificing only the branch on which aneurysm is located. Consequently much of the surrounding arterial circulation is spared. We describe our series of endovascularly treated distal cerebral aneurysms in 2009. This is a retrospective review of seven consecutive patients (five women) with eight distal cerebral aneurysms (four ruptured) who underwent embolization in 2009. Patient ages ranged from 44 to 69 years. Aneurysm size distribution was: seven small (0-10 mm) and one large (11-24 mm). Two aneurysms required a deconstructive approach. Embolization was performed with coils in six cases, and with liquid embolic material Onyx in two cases. Endovascular treatment was successful in all cases. Immediate angiograms revealed complete occlusion in six aneurysms, none with neck remnants, and incomplete occlusion in two aneurysms. On first follow-up (3-6 month) obtained in six patients, five aneurysms showed stabile occlusion, and one recanalization due to coil impaction. None of the patients died. One patient had neurological deficit GOS (Glasgow Outcome Scale) score three caused by parent artery occlusion, which gradually improved to GOS score 4. EVT is safe and effective technique for distal cerebral aneurysms.