Endovascular Coiling as the First Treatment Strategy for Ruptured Pericallosal Artery Aneurysms: Results, Complications, and Follow Up

Abstract

We apply endovascular coiling as the first treatment option for ruptured pericallosal artery aneurysms. We conducted a retrospective analysis of the clinical and radiological outcomes of this treatment strategy and morphological factors associated with the success of endovascular coiling, to assess the safety and feasibility of our management strategy. From January 2003 to January 2012, we attempted endovascular coiling as the first-intention treatment for 30 consecutive patients with ruptured pericallosal artery aneurysms including those with intracerebral hematoma. Twenty-seven cases of ruptured pericallosal artery aneurysms were successfully embolized with coiling whereas three failures required surgery. Four patients experienced periprocedural complications including thromboembolic event in two and hematoma enlargement after coiling in two. A maximum aneurysm diameter of <3 mm was most strongly associated with failure of endovascular coiling. Of the 27 coil-treated aneurysms, immediate angiographic results showed complete aneurysm occlusion in 19 cases, neck remnant in 6, and residual aneurysm in 2. One patient had a major aneurysm recurrence that was uneventfully reembolized. Sixteen of our 30 patients had good outcomes (modified Rankin scale [mRS] 0-2), 7 had moderate disability (mRS 3), and 4 had severe disability (mRS 4-5) at 3 months after treatment. The management strategy for coiling as the first-intention treatment for ruptured pericallosal artery aneurysms has the potential to become an acceptable alternative to surgical clipping for selected cases, although a larger study population and longer follow-up periods are needed before definitive conclusions can be drawn.