Approaches To A-Com Artery Aneurysms: Different Paths For One Goal

BACKGROUND: A-com artery aneurysms are the most common intracranial aneurysms. Clipping and coiling are the two options available for treatment of these aneurysms. Microsurgical clipping, although invasive, is more suitable for the economically challenged sector of our society. AIM:To evaluate the mortality and morbidity of clipping A-com artery aneurysms by different surgical approaches.Settings and Design: This is a non-randomized prospective multiple centre study. MATERIALS AND METHODS:Patients with A-com artery aneurysm fullling the inclusion criteria and managed with microsurgical clipping were included in the study. Patients were evaluated preoperatively and postoperatively with CT Scan Brain (Plain), 3D- CT Angiogram of Brain or Digital substraction Angiography of Brain.STATISTICAL ANALYSIS:Data collection and analysis, was performed using the statistical package for the social sciences version 16 (SPSS, INC, Chicago, IL). RESULTS:A total of 34 patients of A-com aneurysms (non-giant) were included in the study. Male: Female ratio of 1.62:1 with male preponderance. All the aneurysms were microsurgically clipped by either Pterional transsylvian or modied gyrus rectus or interhemispheric approach. The mortality and morbidity in different surgical approaches were analyzed. CONCLUSION:Mortality depends on the preoperative grade of subarachnoid hemorrhage. Type of surgical approach has no relation to mortality or morbidity.

The Efficacy of Simultaneous Bilateral Internal Carotid Angiography during Coil Embolization for Anterior Communicating Artery Aneurysms

OBJECTIVE: Successful coil embolization of anterior communicating (A-com) artery aneurysms requires good visualization and understanding of the entire H complex. Bilateral carotid angiography may optimize anatomical understanding and visualization of the H complex. We therefore assessed the efficacy of simultaneous bilateral internal carotid angiography during coil embolization for A-com artery aneurysms. METHODS: Of the 153 patients with intracranial saccular aneurysms who underwent embolization between July 2008 and December 2009, 12 had A-com artery aneurysms and were embolized under bilateral carotid angiography. Patients were evaluated angiographically, immediately and 6 months (n=11) after embolization, using a 3-point scale (complete, residual neck, residual aneurysm). The safety, performance and efficacy of this approach were retrospectively evaluated. RESULTS: In all patients, bilateral internal carotid artery angiography provided more detailed anatomical information and understanding around the A-com artery, and, in complex situations, it allowed for more effective coil embolization through bilateral routes to the A-com artery. Angiography immediately after embolization showed occlusion of 11 of the 12 (92%) aneurysms, with none of these 11 showing evidence of recanalization at 6 months. CONCLUSION: These findings indicate that simultaneous bilateral carotid angiography during coil embolization of selected complex A-com artery aneurysms provided improved anatomical understanding, and resulted in more effective and safer procedures than typical unilateral angiography.