“Kissing Aneurysms” of the Anterior Communicating Artery Treated with Coil Embolization

Abstract

Purpose:

To present a case of kissing aneurysms of the anterior communicating artery treated with endovascular coil embolization and discuss the advantages and disadvantages of this technique compared with neck clipping.

Case Report:

A 48-year-old man became drowsy and was admitted to the hospital; he had right hemiparesis and aphasia. Computed tomography revealed diffuse subarachnoid hemorrhage; diagnostic angiography identified an aneurysm at the left A1-A2 junction of the anterior communicating artery and another in the distal anterior cerebral artery (ACA). Endovascular coil embolization was performed on the same day. During the procedure, the 3-mm-diameter junctional aneurysm was successfully packed with coils, but an additional aneurysm was suspected; right carotid angiography following embolization of the left aneurysm clearly showed a mirror image aneurysm of the right A1-A2 junction. The right aneurysm was treated using the same technique. The broad-necked ACA aneurysm was unsuitable for embolization, so neck clipping was performed 5 weeks later. The patient was discharged to his home following complete recovery 7 weeks after the coil embolization.

Conclusions:

Kissing aneurysms are a rare and specific type of multiple aneurysms that require caution in diagnosis and surgical management. Endovascular treatment may be suitable because it does not involve dissection around the aneurysms.

Keywords

anterior communicating artery subarachnoid hemorrhage kissing aneurysms endovascular therapy coil embolization

Get full access to this article

View all access options for this article.

References

Yasargil

. Internal carotid artery aneurysms. In: Yasargil

, ed. Microneurosurgery, vol 2. New York City: Thieme Stratton, Inc.; 1984: 33–123.

Harada

Orita

Ueda

. Large kissing aneurysms of the middle cerebral artery: A case report. Classification of kissing aneurysms [in Japanese]. No Shinkei Geka. 2004; 32: 513–517.

Wanifuchi

Shimizu

Higa

. Kissing mirror image anterior communicating artery aneurysms-case report. Neurol Med Chir (Tokyo). 2001; 41: 29–32.

Imai

. Kissing aneurysms of the internal carotid artery: Case report. Jpn J Neurosurg (Tokyo). 2001; 10: 801–806.

Kanai

Yamada

Yamashita

. So-called kissing aneurysms on the same internal carotid artery: Report of two cases [in Japanese]. Jpn J Neurosurg (Tokyo). 1999; 8: 349–354.

Matsumori

Kayama

Kokubo

. A case of non-junctional posterior communicating artery aneurysm forming kissing aneurysms with an IC-PC aneurysm [in Japanese]. Surg Cereb Stroke. 2003; 31: 365–369.

Mori

Fujimoto

Shimada

. Kissing aneurysms of distal anterior cerebral arteries demonstrated by magnetic resonance angiography. Surg Neurol. 1995; 43: 497–499.

Wanifuchi

Tanikawa

Iseki

. Kissing aneurysms between the internal carotid artery and the anterior communicating artery: A case report [in Japanese]. Jpn J Neurosurg (Tokyo). 1998; 7: 694–698.

Date

Ogihara

Tamiya

. “Kissing” bilateral large carotid-opthalmic aneurysms. A case report. Neurosurg Rev. 1998; 21: 281–283.

10.

Ide

Hagiwara

Tanaka

. Bilateral ophthalmic segment “kissing” aneurysms presenting with subarachnoid hemorrhage-case report. Neurol Med Chir (Tokyo). 2002; 42: 427–430.

11.

Jefferson

. The significance for diagnosis and for surgical technique of multiple aneurysms of the same internal carotid artery. Acta Neurochir (Wien). 1978; 41: 23–37.

12.

Komiyama

Yasui

Tamura

. “Kissing aneurysms” of the internal carotid artery. Neurol Med Chir (Tokyo). 1994; 34: 360–364.

13.

Saatci

Cekirge

Karcaaltincaba

. Endovascular treatment of kissing aneurysms at the fenestrated basilar artery: Case report with literature review. Surg Neurol. 2002; 58: 54–58.

14.

Molyneux

Kerr

Stratton

. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: A randomized trial. Lancet. 2002; 360: 1267–1274.