Aneurysm's of the Anterior Communicating Artery

Michele,

As I understand it, the communicating artery is not only very small (mine is only 4 mm long and the aneurysm is 6 mm), but this tiny artery takes the brunt of a lot of pressure as blood flows into/through it from both the right and left cerebral arteries. The anterior communicating artery aneurysm commonly ruptures at smaller than 7 mm, while most other aneurysms become concerning closer to 10 mm.

Heidi C., Utah

Michele said:

Hi,

Can someone explain to me why a small annie on the anterior communicating artery would be "common" to pop? I have been monitoring a 3mm one for about three years, and it has not changed. I see that several people do get clipped and coiled for these small annies. I have been operating under the assumption that only very very rarely would these small annies rupture. Am I being too "optimistic"?

Appreciate your thoughts,

Michele

Michele, if you ara catholic, just trust in God, and everythin will be ok.

I had my surgery of my aneurysm of the anterior communicating artery almost 4 years ago, and I still here I am.

God Bless you and your family, whom are the principal support to face all of this.

My best wishes

Miguel RodrĂ­guez (from Veracruz, Mexico)

Michele said:

Dear Jennifer, Heidi, Jodi and others,

After reading this blog I decided to make an appointment with a specialist at Hopkins. There was a cancellation and so I got an appointment surprisingly quickly. I want to thank you very much for making me aware that the location at the communicating artery (where my aneurysm is located) is a sensitive location. THANK YOU!!! I would not have made the appointment had I not seen this chat.

I have been seeing a neursurgeon here in the suburbs of Washington DC for four years for a 3mm in the communicating artery. Thankfully, it seems to have been stable. When I told the Hopkins doctor that I never had an angiogram, she was extremely surprised. She said there is a lot of misunderstanding out in the world about the relationship between the size of the aneurysm and its rupture risk. She told me that although my aneurysm is small at 3mm, it is in the communicating artery section, where relative to the artery, the aneurysm could be big. She said that at 1% risk/year of a rupture, which given my age of 53, is not insignificant.

I've now got an appointment for an angiogram next week. Like most of you, I am feeling quite anxious. I also am confused, since I thought I was doing the right thing by getting an MRA every 6 months to monitor the aneurysm, to find out now that I was not being followed as closely as I should have.

I do feel like I am in good hands at Hopkins, since they specialize in this field. I hope everything turns out okay.

THANK YOU again. I am grateful for the information you gave me which made me seek a second opinion from a real specialist.

Regards,

Michele

Michele - I’m SO glad you went to Hopkins. I found out the hard way that not all docs/hospitals are equal. Far from it! You will be in great hands there! My amazing surgeon at NYU told me that the angiogram is the “gold standard” for assessing the aneurysm. I’ve had about 4 of them by now, pre and post surgery. It’s a strange sensation when they go in and do the dye, but really not bad at all. And so worth it for them to get a good look.

I was only 42 when mine ruptured in 2013 - I never knew it was there until it ruptured. You are in a much better situation because you know. Best wishes; keep us posted! Jen

I am so glad that you went to Hopkins and that you were able to get right in! God Bless! My doc explained that the MRA is a great tool for discovering/identifying the aneurysm, but that the CT Angiogram is much better for a truly accurate measurement. Additionally, it will often show other arterial anomalies that do not show up in the MRA.

Keep us posted! I don't know about you, but I am a bundle of conflicting emotions, good-bad-in between. It helps me to be able to read your posts and share my own.

Heidi C., Utah

Michele said:

Dear Jennifer, Heidi, Jodi and others,

After reading this blog I decided to make an appointment with a specialist at Hopkins. There was a cancellation and so I got an appointment surprisingly quickly. I want to thank you very much for making me aware that the location at the communicating artery (where my aneurysm is located) is a sensitive location. THANK YOU!!! I would not have made the appointment had I not seen this chat.

I have been seeing a neursurgeon here in the suburbs of Washington DC for four years for a 3mm in the communicating artery. Thankfully, it seems to have been stable. When I told the Hopkins doctor that I never had an angiogram, she was extremely surprised. She said there is a lot of misunderstanding out in the world about the relationship between the size of the aneurysm and its rupture risk. She told me that although my aneurysm is small at 3mm, it is in the communicating artery section, where relative to the artery, the aneurysm could be big. She said that at 1% risk/year of a rupture, which given my age of 53, is not insignificant.

I've now got an appointment for an angiogram next week. Like most of you, I am feeling quite anxious. I also am confused, since I thought I was doing the right thing by getting an MRA every 6 months to monitor the aneurysm, to find out now that I was not being followed as closely as I should have.

I do feel like I am in good hands at Hopkins, since they specialize in this field. I hope everything turns out okay.

THANK YOU again. I am grateful for the information you gave me which made me seek a second opinion from a real specialist.

Regards,

Michele

Bless you for your story! I read it to my husband. We are both buoyed up by your and your wife's experience.

Heidi C., Utah

ADRauch said:

My wife's was 6mm on the right posterior communicating artery 3.5 years ago. We were unaware of it until it ruptured. She was rated at a 5, the worst for loss of body function--she even lost the ability to do everything, even sit up. But today she is virtually normal in the sense that others would not notice any handicap, except sometimes people notice that her left leg is a bit slow. She has less control of her emotions. But considering the hit she took, she has done very well. She also recovered faster than the predictions of rehab. The first predictions were 3 - 5 months of acute rehab, but she accomplished the target goals in two weeks. And not long after she returned to piano teaching (which she had also done beforehand). We are grateful to God for His care and direction.

Knowledge is power. To know beforehand about the aneurysm is surely an advantage. Our doctors were very good, and they were able to do exactly what was needed by way of coiling. I expect that you are in a good position and can expect a very good outcome.

Thank you, Miguel!

I will keep your strength in my heart to remind me to be strong also.


Miguel RodrĂ­guez SĂĄez said:

Good afternoon, Heidi.

My name is Miguel RodrĂ­guez S., I live in Veracruz, MX., and as you, I had my surgery since the 7th September, 2012, with an aneurysm of the anterior communicating artery, which was clipped. The life has changed since then, and with confidence in God and helping us by ourself, it is possible to going ahead. The code is to make all the exercises to help our memory, every day. it's very difficult at the begining, but not imposible; so, keep on your trayning and always have confidence in God; if He left us here, is because one reazon.

My best wishes to you and all of your family.

Miguel Rodríguez (from Veracruz, México).

My surgery is scheduled now... June 10. It seems like such a long wait! I've been struggling with terrible headaches for 4 months (which my surgeon assures me are not related to the aneurysm),but when my head hurts I get so befuddled and emotional.

It's good to have a date though. It's also good to hear that you are scheduled. Prayers, hugs, and more of the same for you!!!!!


Joant said:

I'm having my surgery this week!! I've been so nervous, and scared to death it was going to rupture. I am now feeling so much gratitude for finding it before rupture, and I am so glad the surgery is finally going to take care of it. I will try to let you know how it went before you go--just not sure how long it will be before I can get back on the computer Take care and good luck-I know just how you feel! Joan



heidicalder said:

Joan,

I'm glad I asked too! Thank you for sharing. When will you have your surgery? I am having mine on the 9th of June. I am relieved, anxious, thrilled, and terrified!

Heidi C

Utah


Michele said:

Dear Joan,

Can I ask you who you are seeking at Hopkins? I have a 3 mm unruptured aneurysm in the same location. I've been monitoring it for a few years and it is thankfully stable. After reading this blog, I am thinking of going to Hopkins to get a second opinion, since I live in DC and my neurologist is a surgeon here in DC, but he does not specialize in aneurysms per se. It would be appreciated if you could indicate who you are seeing at Hopkins since you seem to be quite positive about him.her.

With my appreciation,

Michele


Joant said:

Hi Heidi, I am having my 6 mm irregularly shaped unruptured aneurysm with a daughter clipped this week. It's also on my anterior communicating artery I found it incidentally and I feel so fortunate to have found it before rupture. the waiting has been so difficult, but as I approach surgery, my fear is being replaced by relief. I'm going to Johns Hopkins to a wonderful surgeon who has done many of these- they have an aneurysm center there. I am thinking of you and wishing you a good surgery and recovery! Soon, we' ll both be on the other side of this. Take care, Joan. By the way. I'm so glad you asked this question!

God bless you for your faith and positive outlook.

Michele...I am delighted for you...look forward to your update...

I have contemplated, and, have talked w/JH, too, some time back...and, the travel time / cost, has kept me away...not by other choice or anxiety.

Michele said:

Dear Jennifer, Heidi, Jodi and others,

After reading this blog I decided to make an appointment with a specialist at Hopkins. There was a cancellation and so I got an appointment surprisingly quickly. I want to thank you very much for making me aware that the location at the communicating artery (where my aneurysm is located) is a sensitive location. THANK YOU!!! I would not have made the appointment had I not seen this chat.

I have been seeing a neursurgeon here in the suburbs of Washington DC for four years for a 3mm in the communicating artery. Thankfully, it seems to have been stable. When I told the Hopkins doctor that I never had an angiogram, she was extremely surprised. She said there is a lot of misunderstanding out in the world about the relationship between the size of the aneurysm and its rupture risk. She told me that although my aneurysm is small at 3mm, it is in the communicating artery section, where relative to the artery, the aneurysm could be big. She said that at 1% risk/year of a rupture, which given my age of 53, is not insignificant.

I've now got an appointment for an angiogram next week. Like most of you, I am feeling quite anxious. I also am confused, since I thought I was doing the right thing by getting an MRA every 6 months to monitor the aneurysm, to find out now that I was not being followed as closely as I should have.

I do feel like I am in good hands at Hopkins, since they specialize in this field. I hope everything turns out okay.

THANK YOU again. I am grateful for the information you gave me which made me seek a second opinion from a real specialist.

Regards,

Michele

Thank you to all for you encouragement, well wishes, and advice. I appreciate knowing there are people out there who have been through this and who understand. I do appreciate your support!

Michele


Jennifer,what was the size of your ACom anneurysm?
Jennifer said:

Michele - I'm SO glad you went to Hopkins. I found out the hard way that not all docs/hospitals are equal. Far from it! You will be in great hands there! My amazing surgeon at NYU told me that the angiogram is the "gold standard" for assessing the aneurysm. I've had about 4 of them by now, pre and post surgery. It's a strange sensation when they go in and do the dye, but really not bad at all. And so worth it for them to get a good look.

I was only 42 when mine ruptured in 2013 - I never knew it was there until it ruptured. You are in a much better situation because you know. Best wishes; keep us posted! Jen

Hi Iris - mine was between 2 and 3mm.
-Jen



IrisD said:


Jennifer,what was the size of your ACom anneurysm?
Jennifer said:

Michele - I'm SO glad you went to Hopkins. I found out the hard way that not all docs/hospitals are equal. Far from it! You will be in great hands there! My amazing surgeon at NYU told me that the angiogram is the "gold standard" for assessing the aneurysm. I've had about 4 of them by now, pre and post surgery. It's a strange sensation when they go in and do the dye, but really not bad at all. And so worth it for them to get a good look.

I was only 42 when mine ruptured in 2013 - I never knew it was there until it ruptured. You are in a much better situation because you know. Best wishes; keep us posted! Jen

Thanks Jen. Any advice on how to keep the nerves at bay? I find myself being very nervous and fearing the worst. Michele



Jennifer said:

Hi Iris - mine was between 2 and 3mm.
-Jen




IrisD said:


Jennifer,what was the size of your ACom anneurysm?
Jennifer said:

Michele - I'm SO glad you went to Hopkins. I found out the hard way that not all docs/hospitals are equal. Far from it! You will be in great hands there! My amazing surgeon at NYU told me that the angiogram is the "gold standard" for assessing the aneurysm. I've had about 4 of them by now, pre and post surgery. It's a strange sensation when they go in and do the dye, but really not bad at all. And so worth it for them to get a good look.

I was only 42 when mine ruptured in 2013 - I never knew it was there until it ruptured. You are in a much better situation because you know. Best wishes; keep us posted! Jen

Michele, remember statistics is where all the ratings on ruptures, etc come from. So each hospital, in each state or country will often have their own set. There is a way to read the information for key words that it is specific to a hospital such as “in our experience
at our facility
” There is a tremendous study going on across the world for aneurysms. There is also a new procedure introduced on treating small and medium aneurysms.

Now on treating nerves
I’m guessing you mean stress. Identify when you initially become stressed. Is it a rise in BP or pulse, breathing getting faster? This can all be controlled by taking deep breaths in and release. Relaxation breathing
focus on your breathing. Hobbies are good, physical activity is great to level you are able to participate. Talk to your doctor, educate yourself, stay with trusted research sites, use individual stories as support but not expert advise. CBT approach is a good way to learn skills in dealing with stressors.

Hi Michele! I hope that all went well well with your angiogram. Did you see Dr. Pearl? Please let me know what happens-they are wonderful there!! I had my clipping on 5/26 and was released on 6/1. All went well!! I'm home resting and trying to get my strength back- he said about 6-8 weeks. Please stay in touch, Joan

Congrats Joan! You’re on the other side!
Michele - thinking about you and hoping you are well :wink:

  • Jen

Hi Jennifer!! It'll be two weeks this coming Tuesday. I was in for almost a week. My appetite is starting to come back, and I feel stronger everyday. Dr. Tamargo and Johns Hopkins were incredible!! I have about 6-8 weeks recovery, so each day I try to do a little more. Thanks for asking!! Joan

Jennifer said:

Congrats Joan! You're on the other side!
Michele - thinking about you and hoping you are well ;)
- Jen

Dear Heidi

I wish you well on your upcoming surgery; I will hold you in prayer until I hear back from you after your surgery.

Back in March of 2008, I was in the hospital being treated for Diverticulitis. I was complaining of nausea so they decided to do a CT of my head. I was joking that maybe they were looking for a brain tumor, and they said, yes, they were. I had the CT done and they found and anterior communicating artery aneurysm. Sorry, I don’t remember the size of the aneurysm, but if I can remember I will send that info to you. The surgeons were going to operate immediately, but after thinking it through, they thought it would be better to get the diverticulitis cleared-up and then do the brain surgery. During that two week wait, I went to three other doctors/hospitals for their opinions; I went back to the initial doctors and had them do the surgery.

I had had an MRI/MRA done five years prior to March of 2008, because I was having some neurological symptoms after a gyne surgery. I was sent to top neurologist at a teaching hospital. I was told that everything was OK and they did not find anything wrong on the MRI/MRA. They could not explain why I had those neurological symptoms after surgery. They thought maybe it could be from the anesthesia, and said they did not know if it would ever happen again.

Forward to March 2008, while I was in the hospital before having the brain surgery done, I was able to get the report from the MRI/MRA that I had done five years prior. The current surgeons looked at the report and the films and pointed out the anterior communicating artery; It had been missed five years ago. I had been walking around for five years unaware I had a brain aneurysm.

I actually had two doctors work on me; I thought they were both wonderful. I always ask the doctor “what would you do if it were your wife or your loved one having this surgery done”. Before I could even ask that question the surgeon said, if you were my wife, you would be in there tomorrow and we would be doing a clipping. I am 60 years old now; I was 52 at time of surgery.

The other three opinions I had also recommend clipping over coiling. I was told I could have coiling if I really wanted to but it was explained to us that clipping was a one-time thing; after it was clipped it was done. With coiling there would most likely be more surgeries down the road, if the coils shrunk down, more would need to be added, etc. I know I would not be able to psych myself up to come back over and over again. It was explained to us (my husband and family) that with the clipping there were more risks up front, but that, once it is done, it is done for good. They were confident that I would come out of this OK.

As the doctor was wheeling me out of surgery, he saw my husband and told him that my aneurysm was very thin and that I would have been dead within four months if it had not been found.

I do not like having Diverticulitis, but it actually saved my life. If I had not been in the hospital with Diverticulitis I most likely would have died. We are upset that the first doctor missed the aneurysm five years ago, but I feel I was in the right place at the right time and I had the best surgeons doing my surgery.

Before the surgery, during the consult, the surgeon said that my life will change. After the surgery, I will refer to my life as “my life before the brain surgery” and my life “after the brain surgery”. I do not have any severe deficits from the aneurysm surgery. I am very blessed and very thankful!!!!

I do have some other very serious health problems, but the aneurysm surgery went very well and I am thankful to be so fortunate.

I spent one night in ICU and two weeks in the hospital. I was up and walking the next day after ICU (with a PT belt around my waist and a walker), but non the less, up and walking. They get you up and out of the bed no matter what.

I do have some weird sensations on the left side of my head where they went in by the temple, but this is a small price to pay for being alive. I tried Neurontin for this, but even at a low dose it makes me very sleepy; I was diagnosed with narcolepsy while on the Neurontin, so I do not take it. I try to deal with the sensations best I can. These sensations were much worse right after the surgery; the surgeons told me that it was expected as it is healing taking place. They have gotten much better over time. Everyone is different, so I am not saying this will happen to you.

The surgeon did put an acrylic patch in my head near the temple area, he said that people who have this surgery, that usually a few years down the road, their skull starts to sink in, and they have to come back to have an acrylic patch put in. If this has not been told to you by your surgeons, maybe you can ask about that before your surgery.

I have a long history of migraine headaches (since 1980), so I can’t blame them on the brain surgery. I live with chronic pain due to severe fibromyalgia and “inflammatory process of unknown origin”, which also began in 1980, started shortly after the headaches, but again I can’t blame any of this on the aneurysm surgery. In 2010, I was diagnosed with a DVT in my left calf and two Pulmonary Emboli in my lungs, again, can’t blame any of this on the brain surgery.

I’m glad I had the clipping; I am thankful to be alive.

Heidi, I wish you well with your surgery; I will be praying for you.

~Diana

Hello Diana, Having diverticulitis saved your life, but having a brain tumour saved mine. I had been suffering from dizziness and nausea for about a year when a CT showed an acoustic neuroma, it is small and it is a case of watch and wait, but it also showed a 6mm anterior communicating aneurysm. This was also on a watch and wait, but of course 3 months ago it popped. It has been coiled and I am making a good recovery, some headaches but the most debilitating thing is the extreme exhaustion which hits me mid afternoon. I am 73 but have a busy life. The neurosurgeon is very pleased with my progress, but I am not,I want to be back to how I was, I am very stoically and can cope with a great deal. I live in the UK but it seems that treatment is all very much the same, I too am very glad to be alive

My father had an A-comm aneurysm, 5 mm, rupture on Friday morning. He made it to the hospital and did well in the endovascular coil surgery, which we were told are the first two hurdles. Now we are waiting and praying for him as he is fighting in the Neuro ICU. I am so encouraged to hear survival and recovery stories from others who have fought this aneurysm rupture. He has not woken up completely yet, but has been responding to the doctors tests to move or hold up fingers/arms (sometimes he needs a pinch to do it, but he does it). We are told the next 5-7 days are the most crucial to watch out for complications that could lead to stroke, so he will remain in ICU until they are certain he won't have any complications.

Heidi, I wish you the best of luck with the surgery and are so glad you are having it addressed to prevent rupture. Prayers for a speedy recovery from the surgery :)