Endovascular treatment of distal anterior cerebral artery aneurysms: Long-term results

Endovascular therapy is the first-line therapeutic option for intracranial aneurysms, however the results of the endovascular approach for distal anterior cerebral artery (DACA) aneurysms are not well-known. We assessed the immediate and long-term clinical and angiographic outcomes after endovascular coiling of DACA aneurysms.

We performed a retrospective analysis of all consecutive DACA aneurysms treated by endovascular coiling. Procedural complications, clinical, and angiographic results were prospectively recorded in an institutional aneurysm database between 1992 and 2013.

Satisfactory initial occlusion was achieved for 85.9% of cases (79/92). There were three cases of intraprocedural rupture of the aneurysmal sac and three treatment failures, all involving small aneurysms (< 4 mm). Rates of procedure-related mortality and morbidity were respectively 1.1% and 0%. Scores of 5 (good recovery) or 4 (moderate disability) on the Glasgow Outcome Scale, indicating favorable outcome, were observed for 79.3% of patients (73/92) at hospital discharge. In follow-up, 13 cases of recanalization were observed, 12 of which were classified as major. Ten of the recanalizations underwent a complementary intervention.

The endovascular management of DACA aneurysms appears to be efficacious and safe, although certain technical difficulties may emerge when aneurysms are small. A higher proportion of major recanalization events may imply a more frequent deployment of complementary interventions in comparison to aneurysms situated elsewhere.