Endovascular treatment of anterior choroidal artery aneurysms

SummaryIntroductionEndovascular treatment (EVT) of anterior choroidal artery aneurysms (AChAA) may be challenging because of the close relationship with the parent artery. The aim of this study was to report our experience with EVT of AChAA.MethodsA retrospective review of our prospectively maintained database identified all AChAA treated by embolization. The clinical charts, procedural data and angiographic results were reviewed.ResultsFrom April 2004–August 2008, 11 patients were identified. Five patients presented with a subarachnoid hemorrhage (SAH) and six patients were asymptomatic. Aneurysms size varied from two to 13 mm (mean size = 3.6 mm) and nine had an unfavourable neck/sac ratio (≥ 0.7). The anterior choroidal artery was arising from the sac (n = 6) or from the neck (n = 5). Endovascular treatment consisted of balloon-assisted coiling (n = 8), coiling (n = 2) and stent-assisted coiling (n = 1). No procedural complication occurred and all patients had an excellent outcome except one patient who died because of severe vasospasm 8 days after an uneventful EVT. Immediate angiographic control showed six complete occlusions, one neck remnant and four incomplete occlusions. Follow-up controls (mean = 18 months) were obtained in eight patients and showed five stable occlusions and three further thrombosis achieving complete occlusion.ConclusionEVT of AChAA is associated with very good clinical and long-term anatomical results. Because of their small size, unfavourable neck/sac ratio and close relationship with the parent artery, EVT frequently requires the use of adjunctive techniques such as balloon or stent-assisted coiling.