Coil occlusion of the parent artery for treatment of symptomatic peripheral intracranial aneurysms

Abstract

Background and purpose: Peripheral intracranial aneurysms can be difficult to treat with traditional surgical or embolization techniques that spare the parent vessel. We report the results of our use of coil occlusion of the parent vessel for the treatment of nine peripheral intracranial aneurysms.

Methods: During approximately a 4-year period, nine patients (six men and three women, 27 to 68 years old; average age, 42 years) presented to our institution with peripheral intracranial aneurysms. The aneurysms were located on branches of the right posterior inferior cerebellar artery (n = 2), the right superior cerebellar artery (n = 1), the right anterior inferior cerebellar artery (n = 1), the right posterior cerebral artery (n = 3), the left middle cerebral artery (n = 1), and the left anterior cerebral artery (n = 1). Parent vessel occlusion was performed using microcoils after test injection with amobarbital (Amytal) in eight of the nine cases (one patient was comatose and could not be tested before occlusion).

Results: Angiography immediately after the procedure showed aneurysmal occlusion in every patient. Follow-up arteriography, performed in six patients 2 to 12 months after treatment, documented continued aneurysmal occlusion in every case. Three patients exhibited mild, nondisabling neurologic deficits after coil placement; the rest had no new deficits, although one patient was severely disabled from the initial hemorrhage and one patient died of an unrelated cause.

Conclusion: Our results lend support to the use of parent vessel occlusion for peripheral aneurysms that are difficult to treat surgically or that are not amenable to intra-aneurysmal coil placement.

fig 1.

27-year-old man with hemiplegia and aphasia associated with a left parietal lobe hemorrhage who was found to have an aneurysm of the middle cerebral artery (MCA). A and B, Anteroposterior (A) and lateral (B) views of a left internal carotid arteriogram show an aneurysm on the posterior parietal branch of the left MCA. C, A selective MCA arteriogram (lateral view) better shows the aneurysm and the small branch from which it arises. D and E, Anteroposterior (D) and lateral (E) views of a left internal carotid arteriogram after occlusion of the parent vessel no longer show the aneurysm. The aneurysm was trapped by using two 2 × 10-mm coils and 2-mm straight coils.

fig 2.

39-year-old man with sudden onset of severe headaches, nausea, and vomiting who was found to have subarachnoid hemorrhage and an aneurysm of the left superior cerebellar artery (SCA). A, Left vertebral arteriogram (anteroposterior view) shows a small aneurysm on a hemispheric branch of the right SCA. B, Selective right SCA arteriogram (anteroposterior view) better shows the aneurysm. C, Postprocedural right SCA arteriogram (anteroposterior view) shows occlusion of the hemispheric branch and the aneurysm. Five 2-mm straight coils were used for occlusion. Note some retrograde filling of the occluded branch. D, Left vertebral arteriogram (anteroposterior view) obtained 3 months after coil occlusion shows the aneurysm remains occluded.