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Journal of Korean Neurosurgical Society 2005;38(2): 89-95.
Feasibility & Limitations of Endovascular Coil Embolization of Anterior Communicating Artery Aneurysms.
Sung Kyun Hwang, Ronald Benitez, Erol Veznedaroglu, Robert H Rosenwasser
1Department of Neurosurgery, Ewha Womans University School of Medicine, Ewha Medical Research Institute, Seoul, Korea. nshsg@ewha.ac.kr
2Department of Neurosurgery, Thomas Jefferson University School of Medicine, Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
The purpose of this study is to analyze aneurysm morphology and define limitations and feasibility in endovascular Gugliemi detachable coil(GDC) embolization for anterior communicating artery (ACoA) aneurysms. METHODS: From January 2000 through October 2003, 123patients were treated with endovascular coil embolization for ACoA aneurysms. There were 75women and 48men, with a mean age of 63years. All ruptured aneurysms were treated within 15days of rupture. Aneurysm morphology was classified according to neck size and projection of aneurysm dome as follows - A: neck of aneurysm <4mm & anterior projection, B: neck of aneurysm (4mm & anterior projection, C: neck of aneurysm <4mm & posterior (superior) projection, D: neck of aneurysm (4mm & posterior (superior) projection, E: neck of aneurysm <4mm & inferior projection, and F: neck of aneurysm (4mm & inferior projection. Endovascular procedures were categorized as either "successful" or "unsuccessful". Clinical follow-up was estimated at discharge and at 6months, post treatment results were classified according to Glasgow Outcome Scale(GOS) RESULTS: Successful embolization for ACoA was performed in 86patients of 123patients (69.9%). Complete or near complete aneurysm occlusion was observed in 102patients (82.9%); a neck remnant was observed in 6patients (4.9%); partial embolization was done in 3patients (2.4%); and embolization was attempted in 12patients (9.8%). Among 55patients with follow-up angiographic results, 18patients (32.7%) were defined as recanalization of the aneurysm sac. Morphological analysis demonstrated that anterior projecting aneurysms and morphological classifications (morphological classifications worsens (A - D), chances of successful coil occlusion significantly decrease) were major factors in successful embolization, and, inferiorly projecting and wide neck (> or =4mm) aneurysms are highly related to recanalization of aneurysms.
Endovascular coil embolization of ACoA aneurysms shows good outcome in our study. Nevertheless, there is a limitation in the endovascular approach to ACoA, even though advanced modern techniques evolve rapidly. Compensatory surgical approach with the endovascular approach is required for successful treatment of ACoA aneurysms.
Key Words: Aneurysm occlusion; Guglielmi detachable coil embolization; Anterior communicating artery aneurysm; Outcome
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