Ito Yuhei, Ichikawa Tsuyoshi, Tamogami Chisae, Koiwai Megumi, Suzuki Kyouichi
Department of Neurosurgery, Japanese Red Cross Fukushima Hospital, Fukushima, Fukushima, Japan.
J Neuroendovasc Ther. 2025;19(1). doi: 10.5797/jnet.tn.2025-0058. Epub 2025 Jul 29.
Mirror image aneurysms located in the bilateral distal anterior cerebral arteries (ACAs) present significant technical challenges for both microsurgical and endovascular treatment due to their close proximity. To address these complexities, this technical note aims to describe a stepwise endovascular strategy for treating complex bilateral distal ACA kissing and mirror image aneurysms, highlighting key technical modifications such as preemptive bilateral stent deployment and selective microcatheter angiography.
A woman in her 60s presented with bilateral distal ACA mirror image aneurysms (right: 10 mm; left: 7 mm). Endovascular treatment was indicated due to their high-risk morphology and a family history of subarachnoid hemorrhage. To overcome anticipated challenges, a stepwise stent-assisted coil embolization strategy was employed. Key steps included preemptive bilateral Neuroform Atlas stent (Stryker, Kalamazoo, MI, USA) deployment validated by cone-beam CT before any coiling, and selective angiography via a microcatheter left in the proximal A2 segment to ensure clear visualization during coil embolization. The procedure was completed without complications, with no recurrence observed at 5-year follow-up.
The stepwise endovascular strategy, which incorporated preemptive bilateral stent deployment prior to any coiling and utilized selective angiography via microcatheter, enabled the safe and effective endovascular treatment of these complex bilateral distal ACA mirror image aneurysms. This technical strategy offers a practical reference for the endovascular management of similarly complex and anatomically constrained aneurysms.
位于双侧大脑前动脉（ACA）远端的镜像动脉瘤由于位置紧邻，给显微外科手术和血管内治疗都带来了重大技术挑战。为应对这些复杂情况，本技术说明旨在描述一种用于治疗复杂双侧ACA远端吻合及镜像动脉瘤的逐步血管内治疗策略，重点介绍关键技术改进，如预防性双侧支架置入和选择性微导管血管造影。
一名60多岁女性患有双侧ACA远端镜像动脉瘤（右侧：10毫米；左侧：7毫米）。鉴于其高危形态及蛛网膜下腔出血家族史，需进行血管内治疗。为克服预期挑战，采用了逐步支架辅助弹簧圈栓塞策略。关键步骤包括在任何弹簧圈栓塞之前，通过锥形束CT验证后预防性双侧置入Neuroform Atlas支架（史赛克公司，美国密歇根州卡拉马祖），以及通过留在近端A2段的微导管进行选择性血管造影，以确保在弹簧圈栓塞过程中能清晰显影。手术顺利完成，无并发症发生，5年随访未观察到复发。
该逐步血管内治疗策略在任何弹簧圈栓塞之前先进行预防性双侧支架置入，并利用微导管进行选择性血管造影，实现了对这些复杂双侧ACA远端镜像动脉瘤的安全有效血管内治疗。该技术策略为类似复杂且解剖结构受限的动脉瘤的血管内治疗提供了实用参考。
