Intra-procedural complications, success rate, and need for retreatment of endovascular treatments in anterior communicating artery aneurysms: a systematic review and meta-analysis

Yarahmadi, Pourya; Kabiri, Ali; Bavandipour, Amirmohammad; Jabbour, Pascal; Yousefi, Omid

doi:10.1007/s10143-022-01853-w

Cited by 8 publications

(17 citation statements)

References 73 publications

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“…Yarahmadi group also described a pooled IR rate of 4.2% among 3555 ACoA aneurysms, which aligns with our finding of a 2.9% IR rate for ACoA aneurysms. 10 Moreover, many studies reported that an increased likelihood of IR is anticipated for aneurysms that have previously ruptured, as well as for small-sized aneurysms specifically located in the ACoA. 4,[14][15][16] Pierot et al, 17 identified ACoA location (odds ratio, 2.2; P = .03) and small aneurysm size (odds ratio, 3.0; P = .003) as factors associated with IR.…”

Section: Discussionmentioning

confidence: 99%

“…5,9 These findings reflect that despite the advancements in contemporary procedural techniques, addressing these aneurysms has historically posed a significant challenge. 4,10 Our aim is to conduct a retrospective, comparative study to investigate whether advances in EVT technology, approaches, and technique over the past decade have resulted in improvement of the safety profile of ACoA aneurysms measuring ≥4 mm compared with those <4 mm.…”

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confidence: 99%

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Endovascular Treatment of Small Anterior Communicating Artery Aneurysms: Safety and Efficacy in a Contemporary Cohort

Zandpazandi,

Matsukawa,

Porto

et al. 2023

Neurosurgery

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BACKGROUND AND OBJECTIVES: Endovascular treatment (EVT) of small anterior communicating artery (ACoA) aneurysms accompanies a high risk of intraprocedural rupture (IR) because of anatomic location and aneurysm orientation. In this study, we aimed to investigate the safety and efficacy of EVT for small ACoA aneurysms in a contemporary cohort. METHODS: ACoA aneurysms treated at the Medical University of South Carolina between April 2012 and March 2022 were retrospectively analyzed. Periprocedural baseline characteristics, aneurysm size, and clinical and radiological outcomes were collected. Aneurysms were dichotomized into <4 and ≥4 mm in maximum size. The IR rate, favorable occlusion rate (Raymond-Roy I and II), and the favorable outcome defined as modified Rankin Scale 0–2 were compared. RESULTS: A total of 174 patients were identified, of whom 111 (63.8%) were female, and the median age was 57.7 (interquartile range 50.6-69.6) years. 98 (56.3%) aneurysms were ruptured, and 53 (30.5%) were <4 mm. IR was not observed in unruptured ACoA aneurysms, and there was no significant difference in the IR rates between <4 mm and ≥4 mm ruptured aneurysms (6.5% vs 4.5%, P = .65). Favorable occlusion rate and favorable outcome were observed in 94.7% and 78.2% of patients, respectively. CONCLUSION: EVT of small ACoA aneurysms is safe and effective.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Endovascular Treatment of Small Anterior Communicating Artery Aneurysms: Safety and Efficacy in a Contemporary Cohort

Zandpazandi,

Matsukawa,

Porto

et al. 2023

Neurosurgery

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“…EVT is an effective treatment modality for AcomA aneurysms [9], and previous studies have shown that SAC may improve the results of embolization by allowing more complete initial coiling. The success rate of SAC is higher than that of coiling alone, especially in the treatment of wide-necked aneurysms [1,10]. In our cases, all operations were performed under general anesthesia using a SIEMENS ™ biplane angiography system.…”

Section: Sac Treatmentmentioning

confidence: 97%

“…Intracranial aneurysm (IA) is a common cerebrovascular disease, and the anterior communicating artery (AcomA) is the most common site [1], accounting for the highest mortality rate of ruptured aneurysms [2].…”

Section: Introductionmentioning

confidence: 99%

Procedural outcome following and Hemodynamic imaging analysis for anterior communicating artery wide-necked aneurysms by four different stents assisted coil embolization

et al. 2023

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Background: Anterior communicating artery (AcomA) aneurysm is the most common intracranial aneurysm (IA) and has the highest rupture rate. Previously, the preferred surgical treatment for intracranial aneurysms was microsurgery clipping (MC). With the gradual maturation of endovascular treatment (EVT), an increasing number of patients are inclined to treat IA with EVT. In recent years, an increasing number of scholars have suggested that the preferred treatment for wide-necked aneurysms is stent-assisted coiling (SAC). Currently, there are few studies on comparative analyses of the procedural results of SAC in AcomA aneurysms.Methods: We retrospectively reviewed all consecutively treated patients who received SAC for AcomA aneurysms between 12 February 2013, and 20 January 2021. The primary procedural outcome was the occlusion rate evaluated with the Raymond–Roy occlusion classification (RROC) assessed on DSA at follow-up. Safety assessment included 1) ischemic complications (asymptomatic ischemia; intrastent thrombosis; coils falling off plug; arterial dissection); 2) bleeding complications (SAH; ICH); and 3) death. Univariate and multivariate logistic regression analyses were performed to determine patient baseline and aneurysm characteristics associated with total aneurysm occlusion at follow-up. Hemodynamic analysis was performed in one representative case each of the four stents, and six hemodynamic parameters were chosen, including wall shear stress (WSS), cavity blood flow velocity (CBFV), residual blood in the aneurysm (RBA), neck blood flow velocity (NBFV), blood flow inflow (BFI); and inflow concentration index (ICI).Results: A total of 154 patients who underwent EVT via SAC were enrolled for comparative analysis of procedural outcomes. The median age was 55 years, and 56.49% (87) were female. At the first (6–10 months), second (12–15 months) and last (24–48 months) follow-up, complete aneurysm occlusion was observed in 94.8%, 94.8%and 94.2% of patients, respectively. There were no differences regarding the occlusion rates stratified by stent. Each stent showed a variable decrease in all hemodynamic parameters.Conclusion: Hemodynamic parameters all decreased significantly after SAC with all four different stents, and the effect of laser-cut stents on the hemodynamic decline of aneurysms appeared to be more significant than that of woven stents. No significant difference was observed in the follow-up RROC grade among the four stents.

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“… 4 Stent-assisted coiling (SAC) and balloons-assisted coiling (BAC) embolization has been proposed as alternatives to achieve the endovascular reconstruction of complex aneurysms. 5 6 The advent of newer techniques such as flow diversion and the introduction of catheters that are easier to maneuver have made endovascular embolization of ACoAs safer and more feasible. 7 EVT for ACoAs also has difficulties and can be technically demanding.…”

Section: Introductionmentioning

confidence: 99%

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

Saghebdoust,

Barani,

Mehrizi

et al. 2023

Asian J Neurosurg

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Objective In recent years, endovascular methods have been developed to treat intracranial aneurysms. To date, results of endovascular treatment (EVT) for anterior communicating aneurysms (ACoAs) have never been investigated in Iran. Thus, we sought to assess the mid-term angiographic and clinical outcomes of patients with ACoAs who underwent EVT in a tertiary center. Materials and Methods Electronic health documents of patients with ACoAs who underwent EVT from March 2019 to July 2021 were retrospectively reviewed. Demographic and clinical characteristics of patients, procedural and clinical complications along with immediate and 12 months' postprocedural angiographic and clinical results were included in the analysis. Aneurysm occlusion status was classified based on the Raymond–Roy Occlusion Classification (RROC), and clinical outcomes were assessed using the modified Rankin Scale (mRS). Results Of 38 patients with 38 ACoAs, 32 patients (84.21%) presented with subarachnoid hemorrhage of whom 23 (60.52%) had ruptured ACoAs. EVT included simple coiling in 29 patients (76.32%), balloon-assisted coiling in 6 (15.79%), and stent-assisted coiling in 3 (7.89%). Immediate and 12-month postprocedural angiograms demonstrated complete/near-complete occlusion (RROC I and II) in 32 (84.21%) and 35 patients (97.22%), respectively. Periprocedural complications occurred in five patients (13.15%), and the mortality rate was 5.26%. Thirty-two patients (84.21%) had favorable outcomes (mRS 0–2) at the last follow-up. Conclusion EVT is a safe and beneficial procedure with favorable mid-term clinical and angiographic outcomes for ACoAs. Our results can lay the foundation for further studies in developing countries and are satisfactory enough for neurointerventionists to put EVT on the therapeutic agenda of ACoAs.

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Intra-procedural complications, success rate, and need for retreatment of endovascular treatments in anterior communicating artery aneurysms: a systematic review and meta-analysis

Cited by 8 publications

References 73 publications

Endovascular Treatment of Small Anterior Communicating Artery Aneurysms: Safety and Efficacy in a Contemporary Cohort

Endovascular Treatment of Small Anterior Communicating Artery Aneurysms: Safety and Efficacy in a Contemporary Cohort

Procedural outcome following and Hemodynamic imaging analysis for anterior communicating artery wide-necked aneurysms by four different stents assisted coil embolization

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

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