Work

Endovascular Treatment for Kissing and Mirror Image Aneurysms Arising from the Bilateral Distal Anterior Cerebral Arteries: A Technical Note

Year: 2025

Type: article

Abstract: Objective: Mirror image aneurysms located in the bilateral distal anterior cerebral arteries (ACAs) present significant technical challenges for both microsurgical and endovascular treatment due to their close proximity. To address these complexities, this technical note aims to describe a stepwise endovascular strategy for treating complex bilateral distal ACA kissing and mirror image aneurysms, highlighting key technical modifications such as preemptive bilateral stent deployment and selective microcatheter angiography. Case Presentation: A woman in her 60s presented with bilateral distal ACA mirror image aneurysms (right: 10 mm; left: 7 mm). Endovascular treatment was indicated due to their high-risk morphology and a family history of subarachnoid hemorrhage. To overcome anticipated challenges, a stepwise stent-assisted coil embolization strategy was employed. Key steps included preemptive bilateral Neuroform Atlas stent (Stryker, Kalamazoo, MI, USA) deployment validated by cone-beam CT before any coiling, and selective angiography via a microcatheter left in the proximal A2 segment to ensure clear visualization during coil embolization. The procedure was completed without complications, with no recurrence observed at 5-year follow-up. Conclusion: The stepwise endovascular strategy, which incorporated preemptive bilateral stent deployment prior to any coiling and utilized selective angiography via microcatheter, enabled the safe and effective endovascular treatment of these complex bilateral distal ACA mirror image aneurysms. This technical strategy offers a practical reference for the endovascular management of similarly complex and anatomically constrained aneurysms.

Source: Journal of Neuroendovascular Therapy

DOI: 10.5797/jnet.tn.2025-0058

Authors: Yuhei Ito, Tsuyoshi Ichikawa, Chisae Tamogami, Megumi Koiwai, Kyouichi Suzuki

Institution: Fukushima Red Cross Hospital

Language: English

Topic: Intracranial Aneurysms: Treatment and Complications

Subfield: Neurology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $150