Endovascular treatment of ruptured distal anterior cerebral artery aneurysm.

Distal anterior cerebral artery (DACA) aneurysms are less common, accounting for 3.1 to 9.2% of all intracranial aneurysms.The clinical characteristics and surgical techniques are quite different from those of other aneurysms of Willis circle. We aimed to investigate the clinical and radiographic characteristics of ruptured distal anterior cerebral artery (DACA) aneurysms and the efficacy of endovascular treatment for these lesions. From 1998 to 2008, 41 patients with 44 DACA aneurysms were treated by endovascular coiling, including parent vessel occlusion using coils or coils combined with n-butyle-2-cyanoacrylate (NBCA) in two, endosaccular coiling alone in 39, and stent-assisted coiling in three. Technical success was achieved in 40 (97.6%) patients. Among the 41 aneurysms successfully treated with endosaccular coiling or stent-assisted coiling, complete occlusion was obtained in 37, neck remnant in two, and partial occlusion in two. Two patients with poor pretreatment conditions died of cerebral vasospasm. The morbidity was 4.87%. One case each of unruptured recurrence and rebleeding were seen in follow-up DSA of 34 patients and MRA in five cases. Our preliminary results show that endovascular treatment for DACA aneurysms is safe and effective. However, the relative high recurrent rate highlights long-term follow-up for its security.