Husain Shakir, Andhitara Yovita, Jena Somnath Prasad, Padilla Jorge, Aritonang Sahat, Letsoin Igor
Department of Interventional Neurology and Stroke, Institute of Neurosciences, Max Super-Specialty Hospital, Saket, New Delhi, India; Interventional Neurology and Stroke Fellowship Program, Neo Hospital, Noida, India.
Department of Neurology, Dr. Kariadi General Hospital/Faculty of Medicine, Diponegoro University, Semarang, Indonesia.
World Neurosurg. 2017 Nov;107:588-596. doi: 10.1016/j.wneu.2017.08.005. Epub 2017 Aug 18.
Distal anterior cerebral artery (DACA) aneurysms are rare, and their treatment by either surgical clipping or endovascular treatment poses technical difficulties. Earlier studies have reported higher complication rates in DACA aneurysms compared with other aneurysms in the circle of Willis. Therefore, endovascular management of DACA aneurysms still remains a challenge. The aim of this report is to review clinical presentation, angiographic presentation of DACA aneurysms, complications, and outcome of their endovascular treatment in our institutional experience.
A retrospective review of 186 patients with intracranial aneurysms treated with endovascular management from September 2009 to December 2013 in the Max Superspecialty Hospital, New Delhi, India, 11 patients (5.9%) with 12 DACA aneurysms were studied retrospectively. We report the clinical presentations, cerebral angiographic findings, endovascular treatment, complications, and outcomes. The clinical and angiographic outcomes were assessed using modified Rankin scales and the Raymond scale, respectively.
Of 11 patients, 54.5% were female and 45.5% were male; the mean age was 48.4 years (range, 33-65 years). All patients had subarachnoid hemorrhage that indicated ruptured DACA aneurysm. All the DACA aneurysms were small. Postcoiling angiograms showed complete occlusion in 9 patients. Two patients had intraprocedural aneurysm rupture but without any clinical sequelae, and 1 patient had thrombus formation, which was thrombolysed at the end of coiling. All patients had good outcomes.
Our experience with 11 patients showed that endovascular management of small DACA aneurysms, though associated with higher intraprocedural events, is associated with good outcome.
大脑前动脉远端动脉瘤（DACA）较为罕见，采用外科夹闭或血管内治疗均存在技术难题。早期研究报道，与 Willis 环其他动脉瘤相比，DACA 动脉瘤的并发症发生率更高。因此，DACA 动脉瘤的血管内治疗仍是一项挑战。本报告旨在回顾我院 DACA 动脉瘤的临床表现、血管造影表现、并发症及血管内治疗结果。
回顾性分析 2009 年 9 月至 2013 年 12 月在印度新德里马克斯超级专科医院接受血管内治疗的 186 例颅内动脉瘤患者，其中 11 例（5.9%）患者共 12 个 DACA 动脉瘤被纳入回顾性研究。我们报告了临床表现、脑血管造影结果、血管内治疗情况、并发症及治疗结果。分别采用改良 Rankin 量表和 Raymond 量表评估临床及血管造影结果。
11 例患者中，女性占 54.5%，男性占 45.5%；平均年龄为 48.4 岁（范围 33 - 65 岁）。所有患者均发生蛛网膜下腔出血，提示 DACA 动脉瘤破裂。所有 DACA 动脉瘤均较小。弹簧圈栓塞术后血管造影显示 9 例患者动脉瘤完全闭塞。2 例患者术中动脉瘤破裂，但无任何临床后遗症，1 例患者出现血栓形成，在栓塞结束时进行了溶栓治疗。所有患者预后良好。
我们对 11 例患者的经验表明，小型 DACA 动脉瘤的血管内治疗虽然术中事件发生率较高，但预后良好。
