Commentary: Surgical Clipping of an Unruptured Large Inferiorly Projecting Anterior Communicating Artery Aneurysm With Chiasmopathy: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (2) ◽  
pp. E145-E146
Author(s):  
Daniel G Eichberg ◽  
Samir Sur ◽  
Ricardo J Komotar
Author(s):  
Noor Maria

Introduction : We wanted to evaluate the feasibility and results of endovascular treatment in patients with a posteriorly projecting A Com aneurysm and compare surgical clipping with endovascular coiling for posterior projecting anterior communicating artery aneurysm in terms of peroperative technical feasibility and possible complications such as rupture,perioperative complications and postoperative mortality and morbidity. Methods : .Total 6 cases were studied,3 of them (n = 3, 50%)were operated by surgical clipping and 3 (n = 3.50%) underwent endovascular coiling.Average age was 52yrs, 90% were hypertensive, 80% were smokers. All presented through emergency with subarachnoid hemorrhage.2 of the patients in each surgical and endovascular group presented at ER with Hunt and Hess grade 3 (n = 2,33.3%) the others were at Hunt and Hess grade 2 (n = 4,66.6%). The average time from hemorrhage to surgery and coiling was 25days. Outcome assessed using modified Rankin score and a score of 2 was considered satisfactory. Results : In the surgically treated arm 2 patients had mRS of 2 while the 3 rd one had 4.In the endovascular coiling group 1 had mRS of 1,1 had mRS2 and 3 rd had m RS of 3. Despite the very small sample size the outcome in terms of mRS indicated slightly better results for patients undergoing coiling Conclusion: Endovascular coiling is better in the treatment of posteriorly projecting anterior communicating artery aneurysm. Conclusions : Endovascular coiling is better in the treatment of posteriorly projecting anterior communicating artery aneurysm.


2018 ◽  
Vol 64 (6) ◽  
pp. 468-471
Author(s):  
NIANZU YU ◽  
KENJI YATOMI ◽  
TAKASHI FUJII ◽  
KOHSUKE TERANISHI ◽  
MUNETAKA YAMAMOTO ◽  
...  

2021 ◽  
Author(s):  
Miri Kim ◽  
Rachyl Shanker ◽  
Anthony Kam ◽  
Matthew Reynolds ◽  
Joseph C Serrone

Abstract Coaxial support is a fundamental technique utilized by neurointerventionalists to optimize distal catheter control within the intracranial circulation. Here we present a 41-yr-old woman with a previously coiled ruptured anterior communicating artery aneurysm with progressive recurrence harboring tortuous internal carotid anatomy to demonstrate the utility of coaxial support. Raymond-Roy classification of initial aneurysm coiling of class 1 resulted as class 3b over the 21 mo from initial treatment.1 The patient consented to stent-assisted coiling for retreatment of this aneurysm. Coaxial support was advanced as distally as possible in the proximal vasculature to improve catheter control, reducing dead space within which the microcatheter could move, decreasing angulations within proximal vasculature, limiting the movement of the native vessels, and providing a surface of lower friction than the endothelium. As the risk of recurrent subarachnoid hemorrhage in previously treated coiled aneurysms approaches 3%, retreatment occurs in 16.4% within 6 yr2 and in 17.4% of patients within 10 yr.3 Rerupture is slightly higher in patients who underwent coiling vs clipping, with the rerupture risk inversely proportional to the degree of aneurysm occlusion,4 further substantiating that coaxial support provides technical advantage in selected patients where additional microcatheter control is necessary for optimal occlusion. Pitfalls of this technique include vasospasm and vascular injury, which can be ameliorated by pretreatment of the circulation with vasodilators to prevent catheter-induced vasospasm. This case and model demonstration illustrates the technique of coaxial access in the stent-assisted coiling of a recurrent anterior communicating artery aneurysm and identification and management of catheter-induced vasospasm.


2015 ◽  
Vol 6 (02) ◽  
pp. 245-247
Author(s):  
V. R. Roopesh Kumar ◽  
Venkatesh S. Madhugiri ◽  
Gopalakrishnan M. Sasidharan ◽  
Sudheer Kumar Gundamaneni ◽  
Awdhesh Kumar Yadav ◽  
...  

ABSTRACTGiant anterior communicating artery aneurysmsarerare. Apatient presented with visual dysfunction, gait ataxia and urinary incontinence. MRI showed a giant suprasellar mass.At surgery, the lesion was identified as being an aneurysm arising from the anterior communicating artery.The difficulty in preoperative diagnosis and relevant literature are reviewed.


Author(s):  
Jian Zhang ◽  
Anil Can ◽  
Pui Man Rosalind Lai ◽  
Srinivasan Mukundan ◽  
Victor M. Castro ◽  
...  

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