Endovascular Treatment of ACom Intracranial Aneurysms

Abstract

<jats:p> The immediate and long-term outcomes, complications, recurrences and the need for retreatment were analyzed in a series of 280 consecutive patients with anterior communicating artery aneurysms treated with the endovascular technique. From October 1992 to October 2001 280 patients with 282 anterior communicating artery aneurysms were addressed to our center. For the analysis, the population was divided into two major groups: group 1, comprising 239 (85%) patients with ruptured aneurysms and group 2 comprising of 42 (15%) patients with unruptured aneurysms. In group 1, 185 (77.4%) patients had a good initial pre-treatment Hunt and Hess grade of I-III. Aneurysm size was divided into three categories according to the larger diameter: less than 4 mm, between 4 and 10 mm and larger than 10 mm. The sizes of aneurysms in groups 1 and 2 were identical but a less favorable neck to depth ratio of 0.5 was more frequent in group 2. </jats:p><jats:p> Endovascular treatment was finally performed in 234 patients in group 1 and 34 patients in group 2. Complete obliteration was more frequently obtained in group 2 unlike a residual neck or opacification of the sac that were more frequently seen in group 1. No peri-treatment complications were recorded in group 2. In group 1 the peri-treatment mortality and overall peri-treatment morbidity were 5.1% and 8.1% respectively. Eight patients (3.4%) in group 1 presented early post treatment rebleeding with a mortality of 88%. The mean time to follow-up was 3.09 years. In group 1, 51 (21.7%) recurrences occurred of which 14 were minor and 37 major. In group 2, eight (23.5%) recurrences occurred, five minor and three major. Two patients (0.8%) presented late rebleeding in group 1. </jats:p><jats:p> Twenty-seven second endovascular retreatments were performed, 24 (10.2%) in group 1 and three (8.8%) in group 2, seven third endovascular retreatments and two surgical clippings in group 1 only. There was no additional morbidity related to retreatments. </jats:p><jats:p> Endovascular treatment is an effective method for the treatment of anterior communicating artery aneurysms allowing late rebleeding prevention. Peri-treatment rebleeding warrants caution in anticoagulation management. This is a single center experience and the follow-up period is limited. Patients should be followed-up in the long-term as recurrences may occur and warrant additional treatment. </jats:p>

Safety and effectiveness of microsurgical clipping, endovascular coiling, and stent assisted coiling for unruptured anterior communicating artery aneurysms: a systematic analysis of observational studies

“…Six studies reported outcomes for unruptured aneurysms,5 9 14–17 and eight included a mix of patients with ruptured and unruptured cases 2 18–24. Twelve studies2 5 9 14 15 17–23 reported treatment outcomes exclusive to ACoA aneurysms, and two studies16 24 incorporated data on aneurysms at other locations. Documentation of the size among the treated aneurysms was highly heterogeneous among studies, and data on size was largely non-extractable.…”

“…Six studies reported outcomes using the GOS,14 16 17 19 23 24 two using the mRS,5 18 and six using qualitative descriptions 2 9 15 20–22. Coil embolization demonstrated high rates of good clinical outcome (EC 99.2%, MC 95.6%, SAC 92.1%; p=0.001), and corresponding low rates of poor clinical outcome (EC 0.8%, MC 4.4%, SAC 7.9%; p=0.001), in comparison with treatment with MC and SAC.…”

“…2 5 9 14 17 19 22–24 Angiographic follow-up imaging was performed using a combination of DSA and CT angiography,5 14 or CT angiography and MR angiography,19 in studies regarding MC, with studies addressing EC or SAC treatment methods utilizing either MR angiography and DSA,2 17 or DSA alone 9 22–24. Treatment with endovascular techniques led to significantly higher rates of recurrence (EC 7.2%, MC 0%, SAC 12.3%; p<0.001) and retreatment (EC 4.9%, MC 0%, SAC 6.8%; p=0.001) compared with microsurgical repair.…”

Endovascular Treatment of Anterior Communicating Artery Aneurysms: A Systematic Review and Meta-Analysis

“…10,11,15,16 A limited number of case series have detailed the clinical outcomes, angiographic results, and procedure-related complications specific for endovascular treatment in this location. [10][11][12][13][15][16][17][18][19][20][21][22][23][24] We performed a systematic review of the published literature to better define safety and efficacy profiles for coil embolization of AcomA aneurysms beyond single-center experiences.…”

Treatment of complex ruptured anterior communicating arterial aneurysms by endovascular coil embolisation of the anterior communicating artery

“…14,15 Most reported large series of outcome in either intracranial aneurysms coiling or in ACoAAs coiling did not reflect or refer to using this method of ACoA occlusion specifically. [17][18][19] This is because most ACoAAs could be well treated with only coil embolism or with stent/ balloon remodelling. ACoA occlusion could only be the last resort to some complicated ACoAAs.…”