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Risk factors and consequences of unexpected trapping for ruptured anterior communicating artery aneurysms

BACKGROUND: While clipping cerebral aneurysms at the neck is optimal, in some cases this is not possible and other strategies are necessary. The purpose of this study was to describe the incidence, risk factors, and outcomes for inability to clip reconstruct ruptured anterior communicating artery (A...

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Autores principales: Fukuda, Hitoshi, Iwasaki, Koichi, Murao, Kenichi, Yamagata, Sen, Lo, Benjamin W.Y., Macdonald, R. Loch
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4123263/
https://www.ncbi.nlm.nih.gov/pubmed/25101201
http://dx.doi.org/10.4103/2152-7806.136701
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author Fukuda, Hitoshi
Iwasaki, Koichi
Murao, Kenichi
Yamagata, Sen
Lo, Benjamin W.Y.
Macdonald, R. Loch
author_facet Fukuda, Hitoshi
Iwasaki, Koichi
Murao, Kenichi
Yamagata, Sen
Lo, Benjamin W.Y.
Macdonald, R. Loch
author_sort Fukuda, Hitoshi
collection PubMed
description BACKGROUND: While clipping cerebral aneurysms at the neck is optimal, in some cases this is not possible and other strategies are necessary. The purpose of this study was to describe the incidence, risk factors, and outcomes for inability to clip reconstruct ruptured anterior communicating artery (ACoA) aneurysms. METHODS: Of the 70 cases of ruptured ACoA aneurysms between January 2006 and December 2013, our institutional experience revealed four cases of small ACoA aneurysms that had been considered clippable prior to operation but required trapping. When a unilateral A2 segment of anterior cerebral artery (ACA) was compromised by trapping, revascularization was performed by bypass surgery. Clinical presentation, angiographic characteristics, operative approach, intraoperative findings, and treatment outcomes were assessed. RESULTS: Very small aneurysm under 3 mm was a risk factor for unexpected trapping. The reason for unexpected trapping was laceration of the aneurysmal neck in two cases, and lack of clippaple component due to disintegration of entire aneurysmal wall at the time of rupture in the others. Aneurysms with bilateral A1 were treated with sole trapping through pterional approach in two cases. The other two cases had hypoplastic unilateral A1 segment of ACA and were treated with combination of aneurysm trapping and revascularization of A2 segment of ACA through interhemispheric approach. No patients had new cerebral infarctions of cortical ACA territory from surgery. Cognitive dysfunction was observed in three cases, but all patients became independent at 12-month follow up. CONCLUSIONS: Unexpected trapping was performed when ruptured ACoA aneurysms were unclippable. Trapping with or without bypass can result in reasonable outcomes, with acceptable risk of cognitive dysfunction.
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spelling pubmed-41232632014-08-06 Risk factors and consequences of unexpected trapping for ruptured anterior communicating artery aneurysms Fukuda, Hitoshi Iwasaki, Koichi Murao, Kenichi Yamagata, Sen Lo, Benjamin W.Y. Macdonald, R. Loch Surg Neurol Int Original Article BACKGROUND: While clipping cerebral aneurysms at the neck is optimal, in some cases this is not possible and other strategies are necessary. The purpose of this study was to describe the incidence, risk factors, and outcomes for inability to clip reconstruct ruptured anterior communicating artery (ACoA) aneurysms. METHODS: Of the 70 cases of ruptured ACoA aneurysms between January 2006 and December 2013, our institutional experience revealed four cases of small ACoA aneurysms that had been considered clippable prior to operation but required trapping. When a unilateral A2 segment of anterior cerebral artery (ACA) was compromised by trapping, revascularization was performed by bypass surgery. Clinical presentation, angiographic characteristics, operative approach, intraoperative findings, and treatment outcomes were assessed. RESULTS: Very small aneurysm under 3 mm was a risk factor for unexpected trapping. The reason for unexpected trapping was laceration of the aneurysmal neck in two cases, and lack of clippaple component due to disintegration of entire aneurysmal wall at the time of rupture in the others. Aneurysms with bilateral A1 were treated with sole trapping through pterional approach in two cases. The other two cases had hypoplastic unilateral A1 segment of ACA and were treated with combination of aneurysm trapping and revascularization of A2 segment of ACA through interhemispheric approach. No patients had new cerebral infarctions of cortical ACA territory from surgery. Cognitive dysfunction was observed in three cases, but all patients became independent at 12-month follow up. CONCLUSIONS: Unexpected trapping was performed when ruptured ACoA aneurysms were unclippable. Trapping with or without bypass can result in reasonable outcomes, with acceptable risk of cognitive dysfunction. Medknow Publications & Media Pvt Ltd 2014-07-11 /pmc/articles/PMC4123263/ /pubmed/25101201 http://dx.doi.org/10.4103/2152-7806.136701 Text en Copyright: © 2014 Fukuda H http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Original Article
Fukuda, Hitoshi
Iwasaki, Koichi
Murao, Kenichi
Yamagata, Sen
Lo, Benjamin W.Y.
Macdonald, R. Loch
Risk factors and consequences of unexpected trapping for ruptured anterior communicating artery aneurysms
title Risk factors and consequences of unexpected trapping for ruptured anterior communicating artery aneurysms
title_full Risk factors and consequences of unexpected trapping for ruptured anterior communicating artery aneurysms
title_fullStr Risk factors and consequences of unexpected trapping for ruptured anterior communicating artery aneurysms
title_full_unstemmed Risk factors and consequences of unexpected trapping for ruptured anterior communicating artery aneurysms
title_short Risk factors and consequences of unexpected trapping for ruptured anterior communicating artery aneurysms
title_sort risk factors and consequences of unexpected trapping for ruptured anterior communicating artery aneurysms
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4123263/
https://www.ncbi.nlm.nih.gov/pubmed/25101201
http://dx.doi.org/10.4103/2152-7806.136701
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