INTERVENTIONAL NEURORADIOLOGY Endovascular treatment of proximal anterior cerebral artery aneurysms Boris Lubicz & Michaël Bruneau & Aloys Dewindt & Florence Lefranc & Danielle Balériaux & Olivier De Witte Received: 3 September 2008 / Accepted: 24 October 2008 / Published online: 5 November 2008 # Springer-Verlag 2008 Abstract Introduction Aneurysms of the proximal segment of the anterior cerebral artery (A1A) are rare and challenging to treat. No information is available regarding their manage- ment by endovascular approach. The aim of this study was to report our experience with endovascular treatment (EVT) of A1As. Patients and methods A retrospective review of our prospectively maintained database identified all A1As treated in our institution. The clinical charts, procedural data, and angiographic results were reviewed. Results From April 2004 to August 2008, eight patients were identified and presented with an unruptured A1A. All aneurysms but one were <3 mm in diameter and two aneurysms had a perforator at the neck. Surgery was performed in two patients with an aneurysm <2 mm. Six patients were treated by selective embolization including five patients with balloon-assisted coiling (BAC) and/or via a retrograde approach from the contralateral side through the anterior communicating artery. These adjunctive techniques were used to safely catheterize the sac or to protect a branch at the neck. All patients showed an excellent clinical outcome. A complete aneurysm occlusion was obtained in all but one patient. Follow-up imaging in four patients showed stable results. Conclusion EVT of A1As is feasible and associated with good clinical and anatomical results. Because of their location, small size, and close relationship with perforators, EVT frequently requires the use of BAC and/or a retrograde approach. Our results suggest that EVT is an alternative therapeutic option to surgical clipping if the aneurysm size is compatible with selective embolization. Keywords Intracranial aneurysms . Endovascular treatment Introduction Aneurysms of the proximal segment of the anterior cerebral artery (A1A) represent less than 1% of all intracranial aneurysms but they are challenging to treat because of their small size and close relationship with perforators [1–8]. There is no information in the literature concerning their endovascular treatment (EVT). The aim of this study was to report our experience with EVT and imaging follow-up of six patients with A1As. Patients and methods Population See Table 1. Between April 2004 and August 2008, 341 patients with 436 aneurysms were treated in our institution; eight of them had an A1A (1.45%). All A1As were Neuroradiology (2009) 51:99–102 DOI 10.1007/s00234-008-0474-7 B. Lubicz : D. Balériaux Department of Neuroradiology, Erasme University Hospital, Brussels, Belgium A. Dewindt Department of Neurology, Erasme University Hospital, Brussels, Belgium M. Bruneau : F. Lefranc : O. De Witte Department of Neurosurgery, Erasme University Hospital, Brussels, Belgium B. Lubicz (*) Service de Radiologie, Hôpital Erasme, 808 route de Lennik, 1070 Brussels, Belgium e-mail: blubicz@ulb.ac.be