Clinical Study Of Endovascular Treatment Of Anterior Choroidal Aneurysm

Objective: To summarize the clinical experience of endovascular treatment of anterior choroidal artery aneurysm(AChAA),and to evaluate the safety and effectiveness of endovascular treatment of AChAA.Methods: Retrospective analysis of clinical and imaging data of 38 patients undergoing endovascular treatment of AChAA from March 1st,2015 to July 31 st,2018 in the Department of Neurosurgery,Yijishan Hospital of Wannan Medical College.Use statistical methods to analyze the impact of aneurysm size,aneurysm neck-body ratio,and the relationship between aneurysm and AChA on the choice of treatment strategy,analyze the influencing factors of complications during endovascular treatment,and analyze the pre-operative Hunt-Hess classification and treatment strategy of patients The effect of choice on patient prognosis and aneurysm recurrence.Results: A total of 38 AChAA patients were treated with endovascular treatment,including 11 males and 27 females.The ratio of male to female was 1: 2.45.Age: 39-80 years old Mean age: 58.7 ± 9.85 years old.Among them,21 were ruptured aneurysms,17 were unruptured aneurysms,and 3 of them were admitted with oculomotor nerve palsy.Preoperative Hunt-Hess classification: grade 0: 17 cases;grade I: 4 cases;grade II: 10 cases;grade III: 4 cases;grade IV: 3 cases.Preoperative skull CT Fisher classification: grade 0: 17 cases;grade 1: 4 cases;grade 2: 10 cases;grade 3: 3 cases;grade 4: 4 cases.Tiny aneurysms: 13 cases;small aneurysms: 21 cases;general aneurysms: 4 cases,Tiny and small aneurysms accounted for 89.5%.There were 7 cases of narrow carotid aneurysms;4 cases of absolute wide carotid aneurysms;27 cases of fairly wide carotid aneurysms,and wide carotid aneurysms accounted for 81.6%.AChA originated from the internal carotid artery(type A)in 2 cases;autonomic tumor neck(type B)in 34 cases;and 2 cases from the tumor body(type C).All 38 patients were treated with endovascular embolization.Spring coil embolization alone: 21 cases(including 2 cases of double catheter technology);balloon assisted embolization: 3 cases;stent-assisted embolization: 13 cases;triple catheter technique: 1 case.Dense embolism: 22 cases;tumor neck residue: 15 cases;tumor residue: 1 case.During the aneurysm operation,there was no rupture and bleeding.Six cases of AChA thrombosis during the operation,of which 5 were stent-assisted embolization;1 was simple embolization.In 4 patients,MRI of the skull revealed cerebral infarction in the AChA blood supply area,and AChAS appeared after the operation.MRS scores at discharge: 0 points: 30 cases;level 1: 3 cases;level 2: 2 cases;level 3: 2 cases;level 4: 1 case.Cerebral angiography was reviewed in 32 patients from March to December,and 6 patients had recurrence.All 6 patients had no stent placement.Conclusion: Endovascular embolization is safe and effective in the treatment of AChAA.AChAA is mostly a small wide carotid aneurysm and is closely related to AChA.Many treatment strategies are often used for treatment.Stent-assisted embolization has a lower recurrence rate of aneurysms than spring coil embolization and double-catheter technology,but the risk of thrombosis is increased during and after surgery.The Hunt-Hess classification of patients before surgery is still an independent risk factor affecting the prognosis of patients.The higher the classification,the worse the prognosis.Due to the special anatomy of AChAA,the treatment strategy should be selected according to the aneurysm morphology and patient status.