Anterior Communicating Artery Aneurysm: Acute SAH Due to a Small Aneurysm, Coil Occlusion, the Issue of SAH from Small Aneurysms

  • Muhammad AlMatterEmail author
  • Marta Aguilar Pérez
  • Hans Henkes
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The following presentation describes the clinical and radiological findings of a 75-year-old woman who presented due to spontaneous subarachnoid hemorrhage (SAH), caused by the rupture of a very small aneurysm located at the anterior communicating artery (AcomA). The aneurysm was subsequently treated by endovascular placement of a single 3D coil. Good clinical outcome was achieved despite the advanced age of the patient. The complete occlusion of the treated aneurysm was stable over the follow-up period of 24 months. Although the risk of rupture of small and very small aneurysm is allegedly “exceedingly” low, according to International Study of Unruptured Intracranial Aneurysms (ISUIA), yet most of the ruptured aneurysms encountered in daily practice are in fact small. The presented case is just one of innumerous examples of ruptured (very) small aneurysms.


Small aneurysm SAH AcomA Coil Risk of rupture 


  1. AlMatter M, Bhogal P, Aguilar Pérez M, Schob S, Hellstern V, Bäzner H, Ganslandt O, Henkes H. The size of ruptured intracranial aneurysms: a 10-year series from a single center. Clin Neuroradiol. 2017. [Epub ahead of print].
  2. International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms – risk of rupture and risks of surgical intervention. N Engl J Med. 1998;339(24):1725–33.
  3. Korja M, Lehto H, Juvela S. Lifelong rupture risk of intracranial aneurysms depends on risk factors: a prospective Finnish cohort study. Stroke. 2014;45(7):1958–63.
  4. Mocco J, Ransom ER, Komotar RJ, Schmidt JM, Sciacca RR, Mayer SA, Connolly ES Jr. Preoperative prediction of long-term outcome in poor-grade aneurysmal subarachnoid hemorrhage. Neurosurgery. 2006;59(3):529–38.
  5. Nieuwkamp DJ, Rinkel GJ, Silva R, Greebe P, Schokking DA, Ferro JM. Subarachnoid haemorrhage in patients > or = 75 years: clinical course, treatment and outcome. J Neurol Neurosurg Psychiatry. 2006;77(8):933–7.
  6. Schöller K, Massmann M, Markl G, Kunz M, Fesl G, Brückmann H, Pfefferkorn T, Tonn JC, Schichor C. Aneurysmal subarachnoid hemorrhage in elderly patients: long-term outcome and prognostic factors in an interdisciplinary treatment approach. J Neurol. 2013;260(4):1052–60.
  7. Tsutsumi K, Ueki K, Morita A, Kirino T. Risk of rupture from incidental cerebral aneurysms. J Neurosurg. 2000;93(4):550–3.
  8. Wermer MJ, van der Schaaf IC, Algra A, Rinkel GJ. Risk of rupture of unruptured intracranial aneurysms in relation to patient and aneurysm characteristics: an updated meta-analysis. Stroke. 2007;38(4):1404–10.
  9. Yasui N, Suzuki A, Nishimura H, Suzuki K, Abe T. Long-term follow-up study of unruptured intracranial aneurysms. Neurosurgery. 1997;40(6):1155–9.

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Muhammad AlMatter
    • 1
    Email author
  • Marta Aguilar Pérez
    • 1
  • Hans Henkes
    • 1
  1. 1.Neuroradiologische Klinik, NeurozentrumKlinikum StuttgartStuttgartGermany

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