Huang Qinghai, Shen Jie, Xu Yi, Liu Jianmin
Department of Neurosurgery, Changhai Hospital, Shanghai - 200 433, China.
Neurol India. 2010 Mar-Apr;58(2):259-63. doi: 10.4103/0028-3886.63809.
Distal anterior cerebral artery (DACA) aneurysms are less common, accounting for 3.1 to 9.2% of all intracranial aneurysms.The clinical characteristics and surgical techniques are quite different from those of other aneurysms of Willis circle.
We aimed to investigate the clinical and radiographic characteristics of ruptured distal anterior cerebral artery (DACA) aneurysms and the efficacy of endovascular treatment for these lesions.
From 1998 to 2008, 41 patients with 44 DACA aneurysms were treated by endovascular coiling, including parent vessel occlusion using coils or coils combined with n-butyle-2-cyanoacrylate (NBCA) in two, endosaccular coiling alone in 39, and stent-assisted coiling in three.
Technical success was achieved in 40 (97.6%) patients. Among the 41 aneurysms successfully treated with endosaccular coiling or stent-assisted coiling, complete occlusion was obtained in 37, neck remnant in two, and partial occlusion in two. Two patients with poor pretreatment conditions died of cerebral vasospasm. The morbidity was 4.87%. One case each of unruptured recurrence and rebleeding were seen in follow-up DSA of 34 patients and MRA in five cases.
Our preliminary results show that endovascular treatment for DACA aneurysms is safe and effective. However, the relative high recurrent rate highlights long-term follow-up for its security.
大脑前动脉远端动脉瘤（DACA）较少见，占所有颅内动脉瘤的3.1%至9.2%。其临床特征和手术技巧与Willis环其他动脉瘤有很大不同。
我们旨在研究破裂大脑前动脉远端动脉瘤（DACA）的临床和影像学特征以及血管内治疗这些病变的疗效。
1998年至2008年，41例患有44个DACA动脉瘤的患者接受了血管内栓塞治疗，其中2例采用弹簧圈或弹簧圈联合正丁基-2-氰基丙烯酸酯（NBCA）闭塞载瘤动脉，39例单纯瘤内栓塞，3例采用支架辅助栓塞。
40例（97.6%）患者技术成功。在41个成功接受瘤内栓塞或支架辅助栓塞的动脉瘤中，37个完全闭塞，2个有瘤颈残留，2个部分闭塞。2例术前情况较差的患者死于脑血管痉挛。发病率为4.87%。在34例患者的随访数字减影血管造影（DSA）和5例患者的磁共振血管造影（MRA）中分别发现1例未破裂复发和再出血。
我们的初步结果表明，DACA动脉瘤的血管内治疗是安全有效的。然而，相对较高的复发率凸显了对其安全性进行长期随访的必要性。
