Endovascular Parent Artery Occlusion for the Treatment of Wide-Neck A1 Segment Aneurysms: A Single-Center Experience

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Fig 1.
A and B, Left carotid DSA oblique views show the aneurysm on the proximal third of the left A1 segment (A) and the result immediately after EVT (B). C, Right carotid DSA, anteroposterior view, after EVT shows the patency of the AcomA and contralateral A1 segment with filling of the distal left A1 segment. D, Maximum-intensity-projection reconstruction of the left carotid artery on an MRA 2.5 years after EVT.
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Fig 2.
A and B, Right carotid DSAs, anteroposterior view (A) and oblique view (B), show the aneurysm on the distal third of A1 right segment (arrow). C, Right carotid DSA, oblique view, shows the immediate result after EVT. D, Left carotid DSA, oblique view, shows patency of the AcomA and contralateral A1 segment, with filling of the distal right A1 segment. E, Cerebral CT scan the day after EVT shows a stroke of the anterior pallidum and genu of the internal capsule (arrow). F, Control angiography at 3 years shows recanalization of the A1 segment without recurrence of the aneurysm.

Table 1:

Clinical characteristics of patients treated with A1 occlusion and imaging characteristics of aneurysms

Case No.	Age (yr)/Sex	Initial Presentation	Previous Treatment	Location	Size (N/MD) (mm)
1	56/F	Previous SAH	1 (c)	Mid (L)	4/5
2	55/F	Previous SAH	2 (s, c)	Mid (R)	6/15
3	72/M	Previous SAH	1 (c)	Prox (R)	6/12
4	74/F	Incidental	0	Prox (L)	8/20
5	55/F	Incidental	0	Prox (L)	5/10
6	51/F	Incidental	0	Dist (R)	5/12
7	59/F	Incidental	0	Dist (R)	5/9
8	56/F	Decreased visual acuity (OD)	2 (c)	Dist (L)	5/10
9	54/F	Previous SAH	1 (c)	Prox (R)	4/6

Table 2:

Clinical and imaging follow-up

Case No.	EVT	Infarct Post-EVT on CT	Neurologic Deficit	FU (yr)	Last Imaging Findings
1	12/2000	No	0	9	Occlusion
2	03/2001	No	0	7	A1 recanalization, small neck recurrence
3	07/2004	No	0	0.7	Occlusion
4	09/2004	Yes	0	2.5	Occlusion
5	10/2004	No	0	2.5	Occlusion
6	06/2005	No	0	1.5	A1 recanalization, aneurysm occluded
7	11/2006	Yes	0	3	A1 recanalization, small neck recurrence
8	01/2009	Yes	Right hemiparesthesia	0.5	Occlusion
9	06/2009	No	0	0.5	Occlusion