• Cheng-Yu Li, Ching-Chang Chen, Chun-Ting Chen, Po-Chuan Hsieh, Yi-Chou Wang Alvin A Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China., Yi-Ming Wu, Ho-Fai Wong, Mun-Chun Yeap, and Chien-Hung Chang.
• Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.
• World Neurosurg. 2020 Mar 1; 135: e237-e245.

BackgroundProximal anterior cerebral artery (A1) aneurysms are rare among all intracranial aneurysms and are regarded as difficult to treat endovascularly. Treatment is even more challenging in patients with ruptured aneurysms and acute subarachnoid hemorrhage owing to the small size and proximity to perforators. Though challenging, endovascular treatment can provide favorable outcomes in such patients. We report our case series of endovascular treatment in ruptured proximal A1 aneurysms.MethodsBetween January 2010 and December 2017, 1200 aneurysms were treated endovascularly at our center. There were 15 patients with 15 ruptured proximal A1 aneurysms who presented with subarachnoid hemorrhage. Five patients underwent simple coiling, 9 underwent balloon-assisted coiling, and 1 underwent catheter protective coiling. Medical records and angiographic results were obtained retrospectively.ResultsAll aneurysms were successfully treated with endovascular techniques. Multiplicity rate was 53.3% (n = 8). Initial complete obliteration rate was 93.3% (n = 14), with a 13.3% recurrence rate (n = 2). One patient experienced intraoperative bleeding; this was the only procedure-related complication. Eleven patients (73.3%) had a good clinical outcome. When excluding Hunt and Hess grade 4 patients, the good outcome rate was 81.8%.ConclusionsRuptured proximal A1 aneurysm is a rare condition and is highly associated with multiple aneurysms. Despite being a more difficult and complicated technique, endovascular coiling performed in high-volume, experienced medical centers is an effective modality with excellent clinical outcomes.Copyright © 2019 Elsevier Inc. All rights reserved.

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