• Mathew P Cherian, M B Pranesh, Pankaj Mehta, K Vijayan, P Baskar, Tejas M Kalyanpur, and Kaustubh S Narsinghpura.
• Department of Radiology, Kovai Medical Center and Hospital, Avinashi Road, Coimbatore, Tamil Nadu, India. drmathewcherian@gmail.com
• Neurol India. 2011 Mar 1; 59 (2): 218-23.

BackgroundThere have been significant advances in the technical aspects of endovascular therapy of cerebral aneurysms. Anterior communicating artery (Acom A) aneurysms were traditionally treated by surgical clipping. Endovascular coiling has the distinct advantage of being minimally invasive and can be performed anytime during the course of subarachnoid hemorrhage (SAH).AimsTo evaluate the results of endovascular coiling of Acom A aneurysms in the early post-rupture period.Material And MethodsBetween June 1999 and December 2009, 103 Acom A aneurysms were treated with endovascular coiling. All the patients underwent digital subtraction angiography (DSA) and a diagnostic 3D rotational angiogram (3D-RA), followed by coiling using dedicated intracranial coils.ResultsOf the 103 patients coiled, 52% presented in Fischer grade 3/4 SAH and 13.5% in Hunt and Hess grade 4/5. Technical success was 98%. Complete obliteration of the aneurysm was achieved in 97 (94%) patients. Only one patient died of direct procedure-related complication due to coil prolapse. None of the patients had rebleeds. Six-month check angiogram performed in 34 patients showed significant recanalization in one patient.ConclusionRuptured Acom A aneurysms are implicated in majority of cases of SAH. Our results support the latest guideline "that endovascular coil occlusion of the aneurysm is appropriate for patients with a ruptured cerebral artery aneurysm that is deemed treatable either by endovascular coiling or by surgical clipping."

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