Anterior Communicating Artery Aneurysm: Previously Ruptured and Clipped Anterior Communicating Artery Aneurysm; Incidental Aneurysm Recurrence or Remnant; Endovascular Treatment with a Pipeline Embolization Device and Long-Term Follow-Up
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365体育网站A 42-year-old woman underwent microsurgical clipping of a previously ruptured anterior communicating artery (AcomA) aneurysm in another institution, and her follow-up was performed at our institution. Surgery was performed 8 months (after the first rupture) and 3 months (after the second hemorrhage) before being admitted to our clinic. DSA revealed an aneurysm sac remnant or recurrence, which was treated with a Pipeline Embolization Device (Medtronic) with no periprocedural complications. A good clinical outcome and a successfully obliterated aneurysm were confirmed with angiography. MRI ruled out cerebral ischemia. Incompletely treated aneurysms carry a significant risk of rupture and re-rupture, and several strategies for their diagnosis and treatment have been evaluated. Currently, three-dimensional digital subtraction angiography (3D DSA) is considered the imaging method of choice for failed aneurysm surgery evaluation, mainly when multiple clips have been applied or when the remnants are small (≤ 2 mm diameter). Clinical trials have demonstrated low rebleeding rates after microsurgical aneurysm clipping; however, aneurysm remnants and recurrent hemorrhage after clip ligation are well-recognized. If an AcomA aneurysm remnant or recurrence after surgery is identified, repeat microsurgical treatment is not always possible in this location. Retreatment of a previously clipped aneurysm by endovascular means is considered an example of a “hybrid” approach. Such combined treatment strategies bring many advantages to the field, and their origin dates back to the early days of endovascular therapy. Recently published experience with the use of flow diverters for the retreatment of AcomA aneurysms after microsurgical clipping has shown a >80% occlusion rate and a low incidence of complications. The feasibility of flow diversion treatment for remnants and recurrences of previously clipped AcomA aneurysms not amenable to conventional treatment methods is the main topic of this chapter.
KeywordsAnterior communicating artery Pipeline Embolization Device Failed aneurysm surgery Hybrid approach Aneurysm remnant Aneurysm recurrence
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