Comparative outcome analysis of anterior choroidal artery aneurysms treated with endovascular coiling or surgical clipping

Abstract

Background:Treatment of anterior choroidal artery (AChA) aneurysms with endovascular coiling or surgical clipping may increase the risk of ischemic complications owing to the critical territory supplied by the AChA. We analyzed the surgical results of endovascular coiling and surgical clipping for AChA aneurysms performed in a single institution, as well as the role of indocyanine green-videoangiography (ICG-VAG) and motor-evoked potential (MEP).Methods:We analyzed 50 patients (51 aneurysms; 21 men, 29 women; mean age: 58 years) including 25 with subarachnoid hemorrhage treated with endovascular coiling or surgical clipping between April 1990 and October 2013. The complication rates and clinical outcomes of the coil group (mean follow-up: 61 months) and the clip group (mean follow-up: 121 months) were analyzed with a modified Rankin scale.Results:The overall clinical outcome of the coil group (95%) was better than that of the clip group (85%). Especially, the outcomes in the coil group were better in the first investigated period (1990–2007) (P < 0.05). However, after the introduction of ICG-VAG and MEP, the outcomes in the clip group improved significantly (P = 0.005), and treatment-related complications decreased from 20 to 4.7%. Eleven aneurysms (coil group: 8, clip group: 3) showed small neck remnants but no remarkable regrowth, except for 1 case during the mean follow-up period of 91 months.Conclusions:Surgical clipping of AChA aneurysms has become safer because of ICG-VAG and MEP monitoring. Coiling and clipping of AChA aneurysms showed good and comparable outcomes with these monitoring methods.

Outcome analysis of surgical clipping for incidental internal carotid posterior communicating and anterior choroidal artery aneurysms

“…Aoki et al [2] reported a favorable outcome of 79% in the form of no fresh deficits in a retrospective study of 50 patients in Japan who underwent surgical clipping or coiling for incidental IC PC aneurysms.…”

“…This is a finding observed in all the previously compared studies who confirmed the projection of the aneurysm posteriorly in cases who had postoperative complications. [2162221]…”

“…The use of perioperative adjuncts such as MEP and ICG-VAG aids in identifying the vascular anatomy at the site of aneurysm thus minimizing inclusion of crucial perforators while clipping the neck of aneurysm. [2]…”

“…On the other hand, anterior choroidal artery (ACho artery) aneurysms are rare comprising about 2%–5% of all intracranial aneurysms and there are very few case reports involving the microsurgical management of the same. [2] The present study aims at the results of a series of IC PC and ACho artery aneurysms operated at a tertiary referral center.…”

A New Classification of Anterior Choroidal Artery Aneurysms and Its Clinical Application

“…Anterior choroidal artery (AChoA) aneurysms are rare, accounting for approximately 2–5% of all intracranial aneurysms (Locksley et al, 1966 ; Kim et al, 2009 ; Aoki et al, 2016 ). Compared with clipping, endovascular treatment (EVT) is an established treatment option for intracranial aneurysms with shorter hospital stays and better recovery specially in the elderly people (Sadamasa et al, 2014 ).…”