Turkish Neurosurgery
Endovascular Treatment for Ruptured Proximal Anterior Cerebral Artery Dissecting Aneurysm: A case series
Jiro Aoyama1, Sakyo Hirai1, Mariko Ishikawa1, Hirotaka Sagawa1, Kyohei Fujita1, Shoko Fujii1, Tomoyuki Nakano2, Takahiro Ogishima2, Yohei Sato2, Ryosuke Sakai3, Masataka Yoshimura3, Tadahiro Ishiwada4, Kazutaka Sumita1
1Tokyo medical and dental university, Endovascular surgery, Tokyo,
2Japanese red cross musashino hospital, Neurosurgery, Tokyo,
3Tsuchiura kyodo general hospital, Neurosurgery, Ibaraki,
4Shioda memorial hospital, Neurosurgery, Chiba,
DOI: 10.5137/1019-5149.JTN.44098-23.2

Background: Subarachnoid hemorrhage due to the A1 segment of an anterior cerebral artery dissecting aneurysm is rare. Therefore, a standard treatment has not been established. Though several case reports of direct surgery exist, there are few reports on endovascular treatment. This is the first study to describe five patients who underwent endovascular treatment for ruptured A1 dissecting aneurysms. Materials and Methods: Between January 2001 and December 2022 in our affiliated centers, five cases of SAH-onset A1 dissecting aneurysms were treated with endovascular treatment. We describe two representative cases in detail and briefly summarize the other three cases, and analyze their complications and outcomes. Results: In the five cases, four were female. Four were in their 50s, and one was in her 80s. The WFNS grades were as follows: three were 2, one was 4, and one was 5. No re-ruptures or symptomatic complications were observed. The modified Rankin Scale scores at the time of discharge were as follows; one was 0, one was 1, two were 2, and one was 5. One in five patients needed retreatment after endovascular trapping because of recanalization. Conclusions: Endovascular treatment may be an effective and viable treatment option for ruptured A1 dissecting aneurysms. Further studies are needed to collect detailed data on complications and outcomes.

Corresponding author : Kazutaka Sumita