Embolization of Ruptured Aneurysms in the Intracranial Peripheral Arteries Using N-Butyl Cyanoacrylate Glue: A Case Series

Ruptured aneurysms in peripheral arteries are rare, and an optimal treatment strategy has not yet been established. Herein, we evaluated the efficacy and safety of endovascular treatment of peripheral aneurysms located in small, tortuous vessels. In the present study, we report five consecutive cases of small, peripherally located ruptured aneurysms successfully embolized using N-butyl cyanoacrylate glue, with or without the adjunct use of coils. Five ruptured fusiform peripheral artery aneurysms in five consecutive patients were treated with parent artery occlusion using N-butyl cyanoacrylate glue. The etiologies included a flow-related feeder aneurysm associated with cerebral arteriovenous malformation in one case, a mycotic aneurysm associated with infective endocarditis in one case, and unknown causes in three cases. The procedural safety was assessed in advance using a provocation test in combination with the test occlusion of the parent artery with a coil, as required. Complete occlusion of the aneurysm was achieved in all patients, and no instances of postoperative symptomatic cerebral infarction were observed. The patients who attended follow-up showed no recurrence of aneurysms. This study shows that small peripheral artery aneurysms can be effectively embolized endovascularly with high therapeutic efficacy, using an appropriately sized microcatheter, after conducting a thorough safety assessment of parent artery occlusion.