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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 27:142-147, January 2006
© 2006 American Society of Neuroradiology

INTERVENTIONAL

Endovascular Treatment of Intracranial Aneurysms with a Branch Arising from the Sac

B. Lubicz^a, F. Lefranc^b, M. Levivier^b, O. Dewitte^b, B. Pirotte^b, J. Brotchi^b and D. Balériaux^a

^a Department of Neuroradiology, Erasme University Hospital, Brussels, Belgium
^b Department of Neurosurgery, Erasme University Hospital, Brussels, Belgium

Address correspondence to: Boris Lubicz (EA 2691), Service de Radiologie, Hôpital Erasme, 808 route de Lennik, 1070 Bruxelles, Belgium

Abstract

BACKGROUND AND PURPOSE: The endovascular treatment (EVT) of intracranial aneurysms is no more limited by the presence of a branch at the neck or by the neck width. Saccular aneurysms with a branch arising from the sac, however, are mostly candidates for surgery rather than embolization. We prospectively evaluated the feasibility and safety of the EVT in such cases.

METHODS: Between May and November 2004, 9 consecutive patients with a saccular aneurysm that presents a branch arising from the sac were treated by embolization. There were 7 women and 2 men (mean age, 58 years). Six patients presented with a subarachnoid hemorrhage (SAH), and 3 were asymptomatic. All patients were treated by selective coiling with (n = 6) or without (n = 3) the remodeling technique. Clinical outcome was assessed with a modified Glasgow Outcome Scale at 3 months.

RESULTS: EVT was successfully performed in all patients and resulted in 7 excellent outcomes and 2 deaths related to SAH complications. The arterial branch could be preserved in 7 cases and intentionally occluded in 2. Neither embolic nor ischemic complication occurred in the vascular territory of the involved branch. Angiographic results showed 5 neck remnants, 2 incomplete occlusions, and 2 complete occlusions. No rebleeding occurred.

CONCLUSION: Our study, though limited by its small patient population, suggests that saccular intracranial aneurysms with a branch arising from the sac may be treated by endovascular approach with excellent clinical results; however, larger series with long-term follow-up are mandatory to confirm these preliminary results mostly in terms of anatomic stability.

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