Abstract
Introduction
We retrospectively evaluated the ischemic complications related to the anterior choroidal artery (AChA) and clinical outcome after coiling of AChA aneurysms.
Methods
We included 37 patients (27 with subarachnoid hemorrhage, 10 without) harboring 38 AChA aneurysms (23 ruptured, 15 unruptured) who were treated by coiling at four institutions. Ischemic complications related to the AChA and clinical outcomes were retrospectively evaluated.
Results
Intraprocedural transient AChA occlusion occurred in five aneurysms, all of which had AChA incorporated into the aneurysm neck. Two of the five patients suffered postprocedural transient contralateral hemiparesis, but recovered completely. The remaining three patients had no postprocedural symptoms. Incidence of transient AChA occlusion was significantly higher in those aneurysms in which the AChA was incorporated into aneurysm neck (group 2) than in those in which the AChA was not incorporated (group 1). Of the 37 patients, 31 (83.8%) had good recoveries (modified Rankin scale score 0–2). Two patients died from the consequences of subarachnoid hemorrhage. During follow-up for a mean of 27 months (range 4–72 months), none of the 35 living patients re-bled. A total of 29 aneurysms in 28 patients were followed-up angiographically. Recurrences were found in 5 of the 29 aneurysms during follow-up (mean 18 months, range 6–45 months). Re-embolization achieved near complete occlusion of two recurrent aneurysms, both of which were still stable at the time of the next two follow-up angiographies. The other three recurrent aneurysms were not retreated due to the small size of the recurrences.
Conclusion
Coiling of AChA aneurysms resulted in good outcomes without AChA-related permanent ischemic complications. Transient AChA occlusion, potentially associated with ischemic complications, was significantly more frequent in the aneurysm in which the AChA was incorporated into the aneurysm neck.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Flamm ES (1996) Other aneurysms of the internal carotid artery. In: Wilkins RH, Rengachary SS (eds) Neurosurgery. McGraw-Hill, New York, pp 2301–2310
Drake CG, Vanderlinden RG, Amacher AL (1968) Carotid-choroidal aneurysms. J Neurosurg 29:32–36
Yasargil MG, Yonas H, Gasser JC (1978) Anterior choroidal artery aneurysms: their anatomy and surgical significance. Surg Neurol 9:129–138
Viale GL, Pau A (1979) Carotid-choroidal aneurysms: remarks on surgical treatment and outcome. Surg Neurol 11:141–145
Friedman JA, Pichelmann MA, Piepgras DG, Atkinson JL, Maher CO, Meyer FB, Hansen KK (2001) Ischemic complications of surgery for anterior choroidal artery aneurysms. J Neurosurg 94:565–572
Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group (2005) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366:809–817
Piotin M, Mounayer C, Spelle L, Williams MT, Moret J (2004) Endovascular treatment of anterior choroidal artery aneurysms. AJNR Am J Neuroradiol 25:314–318
van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607
Cognard C, Weill A, Spelle L, Piotin M, Castaings L, Rey A, Moret J (1999) Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology 212:348–356
Iijima A, Piotin M, Mounayer C, Spelle L, Weill A, Moret J (2005) Endovascular treatment with coils of 149 middle cerebral artery berry aneurysms. Radiology 237:611–619
Cognard C, Weill A, Castaings L, Rey A, Moret J (1998) Intracranial berry aneurysms: angiographic and clinical results after endovascular treatment. Radiology 206:499–510
Tamatani S, Ito Y, Abe H, Koike T, Takeuchi S, Tanaka R (2002) Evaluation of the stability of aneurysms after embolization using detachable coils: correlation between stability of aneurysms and embolized volume of aneurysms. AJNR Am J Neuroradiol 23:762–767
Thornton J, Debrun GM, Aletich VA, Bashir O, Charbel FT, Ausman J (2002) Follow-up angiography of intracranial aneurysms treated with endovascular placement of Guglielmi detachable coils. Neurosurgery 50:239–249
Hayakawa M, Murayama Y, Duckwiler GR, Gobin YP, Guglielmi G, Vinuela F (2000) Natural history of the neck remnant of a cerebral aneurysm treated with the Guglielmi detachable coil system. J Neurosurg 93:561–568
Murayama Y, Nien YL, Duckwiler G, Gobin YP, Jahan R, Frazee J, Martin N, Vinuela F (2003) Guglielmi detachable coil embolization of cerebral aneurysms: 11 years’ experience. J Neurosurg 98:959–966
Raymond J, Guilbert F, Weill A, Georqanos SA, Juravsky L, Lambert A, Lamoureux J, Chaqnon M, Roy D (2003) Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34:1398–1403
Acknowledgment
Conflict of interest statement
We declare that we have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kim, B.M., Kim, D.I., Chung, E.C. et al. Endovascular coil embolization for anterior choroidal artery aneurysms. Neuroradiology 50, 251–257 (2008). https://doi.org/10.1007/s00234-007-0331-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00234-007-0331-0