Clinical and morphological profile of aneurysms of the anterior communicating artery treated at a neurosurgical service in Southern Brazil

Abstract

Background: The aim of the study was to characterize the clinical profile of patients with anterior communicating artery (ACoA) aneurysms and examine potential correlations between clinical findings, aneurysm morphology, and outcome. Methods: A review of medical records and diagnostic neuroimaging reports of patients treated at a neurosurgical service in Porto Alegre, Brazil, between August 2008 and January 2015 was performed. Results: During the period, 100 patients underwent surgery for ACoA aneurysms. Fifteen had unruptured aneurysms and 85 had ruptured aneurysms. Ruptured aneurysms had a higher aspect ratio than unruptured ones (2.37 ± 0.71 vs. 1.93 ± 0.51, P = 0.02). Intraoperative rupture occurred in 3%, and temporary clipping was performed in 15%. Clinical vasospasm occurred in 43 patients with ruptured aneurysms (50.6%). Overall, mortality was 26%; 25 patients in the ruptured group (29.4%) and one in the unruptured group (6%). The Glasgow Outcome Scale (GOS) was favorable (GOS 4 or 5) in 54% of patients, significantly more so in those with unruptured aneurysms (P = 0.01). In patients with ruptured aneurysms, mortality was associated with preoperative Hunt and Hess (HH) score (P < 0.001), hydrocephalus (P < 0.001), and clinical complications (P < 0.001). Unfavorable outcomes were associated with HH score (P < 0.001), Fisher grade (P = 0.015), clinical vasospasm (P = 0.012), external ventricular drain (P = 0.015), hydrocephalus (P < 0.001), and presence of clinical complications (P = 0.001). In patients with unruptured aneurysms, presence of clinical complications was the only factor associated with mortality (P < 0.001). Conclusion: Despite advances in the management of subarachnoid hemorrhage and surgical treatment of aneurysms, mortality is still high, especially due to clinical complications.

Endovascular treatment of ruptured anterior communicating aneurysms: a 17-year institutional experience with coil embolization

“…Interestingly, in 2020, Jang et al analyzed 77 patients with ruptured ACoA aneurysms treated with coil embolization and found a similar 10% retreatment rate (n=8) 16. The mortality rate found in the present study was only 10% (19/186), which is consistent with earlier endovascular literature (10%–31%) 17–19. Importantly, in the 186 patients treated over the 17-year period, we found no occurrences of aneurysmal rerupture.…”

Endovascular Treatment of Anterior Communicating Artery Aneurysms: A Single-Center Experience from a Developing Country

“…In line with previous studies with mortality rates ranging from 10 to 31%, 22,26,31,32 we have reported a mortality rate of 5.26% in our study. One individual experienced an intraoperative aneurysm rupture and expired within 2 weeks following the endovascular intervention on account of extensive brain damage, while the other one died due to COVID-19 pneumonia 4 months postoperatively.…”

Anatomical features of aneurysms, nature of hemorrhage, severity of angiospasm, and clinical features in Patients with Ruptured Aneurysms of the AComA

“…Additionally, our study revealed that a significant proportion of patients with AComA aneurysm rupture have multiple cerebral artery aneurysms [6]. Therefore, it is important for clinicians to thoroughly evaluate the presence of other cerebral artery aneurysms when planning treatment [7,8].…”