Highlights
- •DACA aneurysm coiling is commonly performed via the ipsilateral A1 segment.
- •DACA aneurysm with sharp ipsilateral A1-A2 angle can result in technical failure.
- •Contralateral transradial system is a useful treatment option for these aneurysms.
- •The A1-A2 angle can be a key anatomical factor for DACA aneurysm coiling.
Abstract
Objective
Endovascular treatment of distal anterior cerebral artery aneurysms is commonly addressed
via the ipsilateral A1 segment of the anterior cerebral artery. However, when the
parent pericallosal artery has a sharp ipsilateral A1-A2 angle, catheterization through
the ipsilateral A1 segment can potentially result in vessel injury, catheter kinking,
and/or compromised/stagnant anterior cerebral artery flow. Here, we present a case
of a distal anterior cerebral artery aneurysm associated with a steep ipsilateral
A1-A2 angle treated with contralateral transradial coil embolization.
Case presentation
A 91-year-old woman presented with a ruptured left distal anterior cerebral artery
aneurysm at the A3 segment. The parent pericallosal artery had a steep ipsilateral
A1-A2 angle. To safely achieve coil embolization of the aneurysm, a contralateral
transradial system via the right A1 segment was employed. Although a secondary ipsilateral
transradial system was required for contrast injection, aneurysm obliteration was
successfully achieved without vessel injury or system instability.
Conclusion
The A1-A2 angle can be a key anatomical factor in the endovascular treatment of distal
anterior cerebral artery aneurysms. The contralateral transradial system is a useful
treatment option for distal anterior cerebral artery aneurysms associated with sharp
ipsilateral A1-A2 angles. However, if the distal anterior cerebral artery aneurysm
cannot be clearly visualized through the contralateral system, an ipsilateral system
will be required for contrast injection.
Key Words
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Article info
Publication history
Published online: January 13, 2022
Accepted:
December 25,
2021
Received:
November 15,
2021
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106299
Copyright
© 2021 Elsevier Inc. All rights reserved.
