Endovascular Treatment for Ruptured Aneurysms at Distal Cerebral Arteries

OBJECTIVE: To evaluate the feasibility and efficacy of endovascular treatment for ruptured aneurysms at distal cerebral arteries. METHODS: A total of 30 ruptured aneurysms at distal cerebral arteries in 30 patients received endovascular treatment (EVT). Distal cerebral arteries were defined as arteries distal to the A2 or M2 segmentations in the anterior circulation, distal to the P2 segmentation in the posterior circulation, or other small branches or perforating arteries. Aneurysm occlusion was assessed using Raymond classification immediately after the procedure and during angiographic follow-up. Clinical follow-up data were retrospectively analyzed and categorized using the modified Rankin scale (MRS). RESULTS: Thirty aneurysms were classified as distal anterior circulation in 17 aneurysms and posterior circulation in 13 aneurysms. EVT technically succeeded in all 30 (100%) aneurysms, with stent assistance in 1 aneurysm and coiling only in 29. Aneurysm sac coiling was done in 25 aneurysms, whereas parent artery occlusion was done in 5 aneurysms. Raymond I occlusion were immediately achieved in 19 of 30 (63.3%) aneurysms. Complications occurred in 1 patient because of aneurysm rupture. Angiographic and clinical follow-up data were obtained from 28 patients. Follow-up angiography (mean, 10.14 +/- 5.31 months) revealed Raymond I classification in 22 aneurysms (78.6%). At the end of clinical follow-up (mean, 11.89 +/- 5.07 months), clinical monitoring using the MRS showed a score of 0 in 18 patients, score of 1 in 5 patients, score of 2 in 2 patients, score of 3 in 2 patients, and score of 4 in 1 patient. CONCLUSIONS: EVT is a feasible and effective therapy to treat ruptured aneurysms located at distal cerebral arteries.