Endovascular treatment of pericallosal aneurysms

Abstract

Object Pericallosal artery aneurysms are uncommon. Their treatment strategy, surgical or endovascular, will present specific challenges. The objective of the study was to compare risks of coil therapy and the recurrence rate of pericallosal artery aneurysms with aneurysms in other intradural locations. Methods The authors examined data that were stored in a prospectively collected database for pericallosal artery aneurysms in patients who underwent coil placement between 1992 and 2005. Hemorrhagic and thromboembolic complications as well as clinical and angiographic outcomes were reviewed. Angiographically documented recurrences were classified as minor or major. These lesions were compared with a historical cohort of non–pericallosal artery aneurysms in patients who underwent coil therapy between 1992 and 2002. The known risk factors for recurrence and procedure-related hemorrhagic complications were evaluated in both groups to assess baseline imbalances. Results During a 13-year period, 25 pericallosal artery aneurysms were treated with coils in 25 patients. The non–pericallosal artery lesion group included 488 aneurysms of which 344 underwent follow-up imaging. Procedure-related perforations were more frequent for pericallosal artery aneurysms than those in other intradural locations (three of 25 compared with eight of 476, respectively; risk ratio 7.1, 95% confidence interval [CI] 2.1–22.5, p = 0.03). Follow-up imaging studies (obtained at a mean 28 months) were available for 19 patients with pericallosal artery aneurysms. The recurrence rate was not significantly higher in these patients (22.9/100 person–years of observation) than in those with non–pericallosal artery aneurysms (17.9/100 person–years of observation) (incidence rate ratio 1.3, 95% CI 0.6–2.4, p = 0.46). Conclusions Pericallosal artery aneurysms were associated with significantly higher periprocedural rupture than non–pericallosal artery lesions. No significant intergroup difference was found for aneurysm recurrence.