Blister-like aneurysm of the anterior communicating artery treated with only Low-profile Visualized Intraluminal Support Junior stent

Abstract

Background: Endovascular treatment is becoming a mainstream treatment for blister-like aneurysms in recent years. Blister-like aneurysms are usually located in the internal carotid artery, whereas that of the anterior communicating artery (AcomA) are very rare. We report the first case of blister-like aneurysm of AcomA that was treated solely with a neck bridging stent that resulted in complete occlusion without complication.

Case description: A 50- year- old woman was admitted to our hospital due to a subarachnoid hemorrhage. Digital subtraction angiography showed a very small aneurysm in the dorsal side of the AcomA. We considered it a blister-like aneurysm based on its size and shape. She underwent endovascular treatment under general anesthesia on day 15 after vasospasm period. Dual antiplatelet therapy was administrated 1 week prior. A Low-profile Visualized Intraluminal Support Junior stent was implanted from the left A2 to the right A1, covering the AcomA. The postoperative course was uneventful, and she was discharged with no neurological deficit. The aneurysm remained unchanged on postoperative day 14; however, complete occlusion was achieved 3 months after the treatment.

Conclusion: Monotherapy with a neck bridging stent is an effective treatment option for blister-like aneurysms. Treatment with a single stent could achieve complete occlusion especially if the aneurysms occur elsewhere than the internal carotid artery. We should consider immediate additional treatment if the aneurysm grows within 1 month after initial treatment.

Keywords: Anterior communicating artery; Blister- like aneurysm; Neck bridging stent.

Figure 1:

Computed tomography upon admission showing subarachnoid hemorrhage (a). Posterior-anterior view of preoperative 3D rotation angiography (3D- RA) demonstrating a small and irregular shaped aneurysm of the dorsal anterior communicating artery with a diameter of 1.5 mm (b; arrow).

Figure 2:

Postoperative cone beam computed tomography showing the implanted Low-prolife Visualized Intraluminal Support Junior stent from the left A2 to the right A1 covering the anterior communicating artery (a). 3D- RA at 3 months after the treatment demonstrating complete occlusion of the aneurysm (b).