Outcome in 43 patients with distal anterior cerebral artery aneurysms

• Published in: Stroke (1970) Vol. 28; no. 12; pp. 2405 - 2409
• Main Authors: PROUST, F, TOUSSAINT, P, HANNEQUIN, D, RABENENOÏNA, C, LE GARS, D, FREGER, P
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.12.1997; American Heart Association, Inc
• Subjects: Adolescent; Adult; Aged; Aneurysm, Ruptured - complications; Aneurysm, Ruptured - surgery; Aneurysm, Ruptured - therapy; Biological and medical sciences; Cerebral Arteries - surgery; Cerebral Hemorrhage - etiology; Disease Progression; Embolization, Therapeutic; Female; Glasgow Coma Scale; Humans; Intracranial Aneurysm - complications; Intracranial Aneurysm - physiopathology; Intracranial Aneurysm - therapy; Male; Medical sciences; Middle Aged; Neurosurgery; Postoperative Complications; Retrospective Studies; Skull, brain, vascular surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Human; Intracranial; Nervous system diseases; Prognosis; Radiodiagnosis; Angiography; Instrumentation therapy; Cardiovascular disease; Endovascular route; Anterior cerebral artery; Hemorrhage; Cerebral disorder; Arterial disease; Vascular disease; Dissecting aneurysm; Treatment; Surgery; Central nervous system disease; Adult; Embolization; Severity score; Predictive factor; Cerebrovascular disease
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.28.12.2405

The aim of this retrospective multicenter study was to evaluate the outcome of distal anterior cerebral artery (DACA) aneurysms and to determine the incidence, causes, and consequences of unfavorable outcomes. 43 patients with 50 DACA aneurysms (27 females and 16 males, mean age 49 years) were studied retrospectively. Forty-four DACA aneurysms were treated surgically (83% with an interhemispheric approach), and 2 were embolized. At postoperative day 10, all patients underwent routine angiography. The outcome at 6 to 12 months was scored according to the Glasgow Outcome Scale (GOS). 35 DACA aneurysms were ruptured. Among the 26 "good"-grade patients (Hunt and Hess grades I through III), 18 (69.2%) were in GOS 1, 2 in GOS 2 (7.7%), 2 in GOS 3 (7.7%), and 4 in GOS 5 (15.4%); among the 9 "poor"-grade patients (Hunt and Hess grades IV and V), 1 (11.1%) was in GOS 1, 2 in GOS 2 (22.2%), 2 in GOS 3 (22.2%), and 4 in GOS 5 (44.5%). The initial intracerebral hemorrhage (ICH) (40%) induced neurological aftereffects in 8 patients. An operative rupture occurred in 40%, with a temporary occlusion in 28.6% that was responsible for mediocre results in 3 patients (8.7%). A postoperative thrombosis was observed in 4 patients (11.4%) and an aneurysmal remnant in 1 (2.8%). Ten DACA unruptured aneurysms were clipped without operative rupture or thrombosis. The authors suggest that the proportion of ruptured DACA aneurysms evolving to a GOS 1 or 2 was similar to that of aneurysms found in other locations, after early surgery. Endovascular treatment should be considered in the management of uncommon ruptured fusiform DACA aneurysms.