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Objective: Distal anterior cerebral artery (DACA) aneurysms are rare, accounting for 1–9% of all intracranial aneurysms. These aneurysms, however, are challenging to treat using surgical clipping and endovascular coiling. Nevertheless, according to recent reports, advances in endovascular therapy devices and technologies have produced better results. We therefore aimed to assess the current status of endovascular treatment of DACA aneurysms. Methods: Between 2004 and 2017, we treated 47 consecutive patients with 49 DACA aneurysms using endovascular coiling at Juntendo University Hospital and entered them into a database. In this retrospective study, we reviewed the patients’ clinical presentation, radiographic findings, endovascular management, and outcomes. The results were then compared with those in the previous literature for DACA aneurysms that were treated by surgical clipping. Results: Among the 49 aneurysms, 15 (30.6%) presented with subarachnoid hemorrhage (SAH). Nine cases were lost to follow-up. Among the 15 aneurysms with SAH, 13 became Hunt and Hess grades I–III and 2 were grade IV. Intracerebral or intraventricular hematoma occurred in five patients with ruptured aneurysms. The mean aneurysm dome measured 4.6 mm (range 1.8–10.5 mm), and the mean aneurysm neck was 2.5 mm (range 0.7–5.6 mm). Altogether, 22 of the 49 aneurysms (44.9%) arose from the origin of the callosomarginal artery. After the initial procedure, complete occlusion (CO) and residual neck (RN) were achieved in 63.3% of the cases. Periprocedural complications were minimal, including one intraoperative rupture and two cases in which thromboembolization was happened, although one case of hemorrhage was asymptomatic. There was one death, and five aneurysms required reoperation. Conclusion: Endovascular coiling to treat DACA aneurysms is useful and can replace surgical clipping. However, the coil’s recanalization rate was higher with the endovascular coil treatment than with surgical clipping, and long-term follow-up is often necessary.

Endovascular Therapy of Distal Anterior Cerebral Artery Aneurysms: Single-institution Clinical Experience with 47 Patients (49 Aneurysms)