Huang SX, Ai XP, Kang ZH, Chen ZY, Li RM, Wu ZC, Zhu F. Endovascular treatment of ruptured lobulated anterior communicating artery aneurysms: A retrospective study of 24 patients. World J Clin Cases 2024; 12(15): 2529-2541 [PMID: 38817240 DOI: 10.12998/wjcc.v12.i15.2529]
Corresponding Author of This Article
Zu-Chao Wu, PhD, Research Scientist, Department of Neurosurgery, Sanming First Hospital Affiliated to Fujian Medical University, No. 29 Liedongjie, Meilie District, Sanming 365000, Fujian Province, China. 282161043@qq.com
Research Domain of This Article
Neuroimaging
Article-Type of This Article
Clinical Trials Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Sheng-Xuan Huang, Xun-Ping Ai, Ze-Hui Kang, Zhi-Yong Chen, Ren-Man Li, Zu-Chao Wu, Feng Zhu, Department of Neurosurgery, Sanming First Hospital Affiliated to Fujian Medical University, Sanming 365000, Fujian Province, China
Author contributions: Huang SX and Ai XQ performed the expriment, wrote the original manuscript; Kang ZH, Chen ZY, and Li RM contributes to the data collection and analysis; Wu ZC and Zhu F designed the experiment and revised the manuscript.
Supported byFujian Province Health Young and Middle-aged Backbone Personnel Training Project, No. 2021GGB022; and Fujian Medical University Sailing Fund, No. 2019QH1262.
Institutional review board statement: The study was reviewed and approved by the Sanming First Hospital Affiliated to Fujian Medical University Institutional Review Board (No. SFH23051).
Clinical trial registration statement: This study was registered by ClinicalTrials. The registered number is No. 04371253.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors have no conflicts of interest to disclose.
Data sharing statement: The data is available from the corresponding author based on reasonable request.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zu-Chao Wu, PhD, Research Scientist, Department of Neurosurgery, Sanming First Hospital Affiliated to Fujian Medical University, No. 29 Liedongjie, Meilie District, Sanming 365000, Fujian Province, China. 282161043@qq.com
Received: November 20, 2023 Revised: February 21, 2024 Accepted: April 8, 2024 Published online: May 26, 2024 Processing time: 176 Days and 6 Hours
Abstract
BACKGROUND
Lobulated intracranial aneurysm is a special type of aneurysm with at least one additional cyst in the neck or body of the aneurysm. Lobulated intracranial aneurysm is a complex aneurysm with complex morphology and structure and weak tumor wall, which is an independent risk factor for rupture and hemorrhage. Lobular aneurysms located in the anterior communicating artery complex account for 36.9% of all intracranial lobular aneurysms. Due to its special anatomical structure, both craniotomy and endovascular treatment are more difficult. Compared with single-capsule aneurysms, craniotomy for lobular intracranial aneurysms has a higher risk and complication rate.
AIM
To investigate the efficacy and safety of endovascular treatment for ruptured lobulated anterior communicating artery aneurysm (ACoAA).
METHODS
Patients with ruptured lobulated ACoAA received endovascular treatment in Sanming First Hospital Affiliated to Fujian Medical University from June 2020 to June 2022 were retrospectively included. Their demographic, clinical and imaging characteristics, endovascular treatment methods and follow-up results were collected.
RESULTS
A total of 24 patients with ruptured lobulated ACoAA were included, including 9 males (37.5%) and 15 females (62.5%). Their age was 56.2 ± 8.9 years old (range 39-74). The time from rupture to endovascular treatment was 10.9 ± 12.5 h. The maximum diameter of the aneurysms was 5.1 ± 1.0 mm and neck width were 3.0 ± 0.7 mm. Nineteen patients (79.2%) were double-lobed and 5 (20.8%) were multilobed. Fisher's grade: Grade 2 in 16 cases (66.7%), grade 3 in 6 cases (25%), and grade 4 in 2 cases (8.3%). Hunt-Hess grade: Grade 0-2 in 5 cases (20.8%), grade 3-5 in 19 cases (79.2%). Glasgow Coma Scale score: 9-12 in 14 cases (58.3%), 13-15 in 10 cases (41.7%). Immediately postprocedural Raymond-Roy grade: grade 1 in 23 cases (95. 8%), grade 2 in 1 case (4.2%). Raymond-Roy grade in imaging follow-up for 2 wk to 3 months: grade 1 in 23 cases (95.8%), grade 2 in 1 case (4.2%). Follow-up for 2 to 12 months showed that 21 patients (87.5%) had good functional outcomes (modified Rankin Scale score ≤ 2), and there were no deaths.
CONCLUSION
Endovascular treatment is a safe and effective treatment for ruptured lobulated AcoAA.
Core Tip: For ruptured lobulated anterior communicating artery aneurysm, preoperative angiography was used to fully evaluate the lobulated aneurysm, neck of the tumor and segment A and 1 vessels, to grasp reasonable operation timing, and to minimize the use of multiple or simplified systems for endovascular treatment during the operation, which was conducive to surgical safety and to reduce postoperative complications.
