RESUMEN
BACKGROUND: Saccular aneurysms of the proximal A1 segment (SAPA1) are rare, but their treatment is challenging and scarcely described in the literature. We report the immediate and long term outcomes of their endovascular management. METHODS: We retrospectively analyzed all consecutive SAPA1 cases treated endovascularly at our center between 2003 and 2023. Per procedural complications and radioclinical outcomes were prospectively recorded. RESULTS: Among 2468 patients followed up for aneurysms, 12 (0.49%) had an SAPA1 (average age 53.8±9.6 years, 9 women). The SAPA1 averaged 3.3 mm, all posteriorly oriented. Ten were ruptured (83.3%). Initial treatments included conventional coiling or balloon assisted coiling (CC/BAC) for nine aneurysms, and proximal A1 segment focal occlusion (PA1FO) for three. Initial occlusion was deemed satisfactory in all instances: total occlusion in eight cases (67%) and subtotal occlusion in four cases (33%). Four aneurysmal perforations occurred (33%), all during CC/BAC on ruptured aneurysms. Over a 10.2 year average follow-up, six recanalizations (50%) were noted, all after initial CC/BAC: three were early (≤14 days), with one causing fatal rebleeding. No recanalizations after PA1FO was observed (five in total, two as a complement after CC/BAC). Favorable clinical outcomes (modified Rankin Scale score of 0-2) were seen in 91% of cases (11/12) at the last follow-up. CONCLUSIONS: Selective coiling of the aneurysmal sac is technically difficult due to their small size and the complex microcatheterization pathway. This method presents a significant risk of aneurysmal perforation, especially in ruptured cases, and a high rate of recanalization. PA1FO, when collateralization permits, appears to be a reliable therapeutic alternative offering favorable long term outcomes.
RESUMEN
Stenting of the dural venous sinuses has emerged as a therapeutic option for intracranial hypertension and pulsatile tinnitus. However, venous endovascular navigation faces challenges due to lower-quality roadmaps compared to arterial navigation. This study explores the application of three-dimensional (3D) rotational venography in assessing the cerebral venous vasculature and its potential for venous navigation. The methods involve venous 3D digital subtracted angiography (DSA) in patients with dural venous stenosis, with image acquisition using a biplane angiographic system. The results highlight the enhanced spatial resolution of 3D venous imaging, providing anatomical information crucial for precise characterization of stenosis and understanding cortical venous drainage. 3D venous roadmapping is shown to improve endovascular venous navigation, offering synchronized and rotatable 3D roadmaps, providing a comprehensive approach to optimize endovascular venous interventions.