ORIGINAL RESEARCH INTERVENTIONAL Endovascular Management of Distal ACA Aneurysms: Single- Institution Clinical Experience in 22 Consecutive

BACKGROUND AND PURPOSE: Distal ACA aneurysms remain difficult to treat with endovascular therapy, but improved technology and experience allows for the treatment of some of these aneurysms with excellent results. The purpose of this study was to assess the status of endovascular treatment of distal ACA aneurysms by comparing our results with recent endovascular and microsurgical series of distal ACA aneurysms. MATERIALS ANDMETHODS: Between 2000 and 2008, a total of 22 consecutive patients (14 women;mean age, 58.4 years) with distal ACA aneurysms underwent coil placement at Barrow Neurological Institute. Clinical presentations, radiographic findings, endovascular man-agement, and outcomes were reviewed retrospectively. RESULTS: Of the 22 patients, 13 (59%) presented with subarachnoid hemorrhage. Six patients were HH grade I or II, 1 was grade III, 5 were grade IV, and 1 was grade V. Frontal lobe hematomas occurred in 5 patients with ruptured aneurysms. The mean aneurysm size was 7.5 mm (range, 2.8–25 mm); 55 % were smaller than 7 mm. Twelve aneurysms (55%) arose from the origin of the callosomarginal artery (55%). Complete occlusionwas achieved in 50%of the cases and near-complete occlusion in 45%. The fewperiprocedural complications included 1 retroperitoneal hematoma and 1 intraoperative rupture. Four patients had thromboembolic events adequately treated intraprocedurally with abciximab. No deaths occurred in the patients treated. CONCLUSIONS: The characteristics of the patients and aneurysms treated in our series were comparable to previous reports of endo-vascular treatment of ACA aneurysms with respect to rupture status. Periprocedural morbidity and mortality rates in our series fared well compared with previous reports, as did our combined rate of complete or near-complete occlusions. Recent advances in endovascular devices and techniques have improved outcomes of distal ACA aneurysms. ABBREVIATIONS: ACA anterior cerebral artery; GOS Glasgow Outcome Scale; HH Hunt and Hess; ICH intracerebral hematoma; ISAT Internationa