Shin Seung Ho, Cho Won Ho, Cha Seung Heon, Ko Jun Kyeung
Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea.
J Cerebrovasc Endovasc Neurosurg. 2022 Dec;24(4):393-397. doi: 10.7461/jcen.2022.E2021.12.001. Epub 2022 Jul 12.
Vascular anomaly and aneurysmal formation of an anterior communicating artery (ACOM) complex has often been reported. Because of such a complicated relationship between the vascular structure and aneurysms, ACOM aneurysm is one of the most difficult aneurysms to treat among other common anterior circulation aneurysms. We herein report a case of wire perforation of a missed tiny aneurysm arising from the fenestrated A1 segment during the endovascular approach to ACOM aneurysm. Although the fenestration of A1 segment is a rare vascular anomaly, it is likely to accompany saccular type aneurysms in the vicinity of the vascular anomaly. Endovascular treatment for ACOM aneurysm requires more detailed evaluations of the accompanying vascular anomaly and hemodynamics around ACOM to avoid complications.
前交通动脉（ACOM）复合体的血管异常和动脉瘤形成经常被报道。由于血管结构与动脉瘤之间存在如此复杂的关系，ACOM动脉瘤是其他常见前循环动脉瘤中最难治疗的动脉瘤之一。我们在此报告一例在ACOM动脉瘤血管内治疗过程中，因遗漏起源于A1段开窗处的微小动脉瘤而导致导丝穿孔的病例。虽然A1段开窗是一种罕见的血管异常，但在血管异常附近很可能伴有囊状动脉瘤。ACOM动脉瘤的血管内治疗需要对伴随的血管异常和ACOM周围的血流动力学进行更详细的评估，以避免并发症。
