Outcome of ruptured anterior communicating artery aneurysm treatment compared between surgical clipping and endovascular coiling: A single-center analysis

Abstract

The optimal treatment modality for ruptured anterior communicating artery (ACoA) aneurysms is unclear. Therefore, in this study, we aimed to compare the outcomes of endovascular coiling and surgical clipping to treat ruptured ACoA aneurysms. A retrospective analysis of 213 consecutive patients with ruptured AcoA aneurysms, who were treated with coiling or clipping between January 2010 and December 2020, was conducted. Of the 213 patients, 94 and 119 underwent clipping and coiling, respectively. The mean age was higher in the coiling group than in the clipping group (60.3 ± 13.2 vs. 53.5 ± 13.4, P < .001). The mean diameter of the aneurysmal neck was larger in the clipping group (3.4 mm vs. 3.0 mm, P = .022), whereas the dome-to-neck ratio (1.53 ± 0.52 vs. 1.70 ± 0.60, P = .031) and aspect ratio (1.67 ± 0.51 vs. 1.92 ± 0.77, P = .005) were larger in the coiling group. The prevalence of vasospasm was higher in the clipping than in the coiling group (42.6% vs. 26.9%, P = .016). The coiling group had a shorter mean intensive care unit hospitalization (18.3 vs. 12.1, P = .002) and more frequently showed favorable outcomes (Glasgow Outcome Scale 4, 5; 57.4% vs 73.1%, P = .016) compared to the clipping group. Multivariable logistic analysis showed that good initial WFNS grade (odds ratio [OR] = 6.69, 95% confidence interval [CI]: 2.69-16.65, P < .001), treatment with coiling (OR = 3.67, 95% CI: 1.70-7.90, P = .001), and absence of the need for cerebrospinal fluid diversion (OR = 5.21, 95% CI: 2.38-11.39, P < .001) were independent predictors of favorable outcomes in patients with ruptured ACoA aneurysms. Ruptured ACoA aneurysms can be safely and effectively treated using both clipping and coiling modalities. However, it may be beneficial to consider coiling as the first option for treating these aneurysms.

The safety and clinical outcomes of endovascular treatment versus microsurgical clipping of ruptured anterior communicating artery aneurysms: a 2-year follow-up, multicenter, observational study

“…Therefore, we conclude that EVT for ruptured AComA aneurysms offers a better functional outcome compared to MC. This finding aligns with a recent single-center analysis showing a 3-month favorable outcome rate of 73.1% in coiling group and 57.4% in clipping group ( p = 0.016) ( 4 ). Further multivariate analysis confirmed that coiling was an independent predictor of good outcomes in patients with ruptured AComA aneurysms (OR = 3.67, 95% CI: 1.70–7.90, p = 0.001) ( 4 ).…”

“…This finding aligns with a recent single-center analysis showing a 3-month favorable outcome rate of 73.1% in coiling group and 57.4% in clipping group ( p = 0.016) ( 4 ). Further multivariate analysis confirmed that coiling was an independent predictor of good outcomes in patients with ruptured AComA aneurysms (OR = 3.67, 95% CI: 1.70–7.90, p = 0.001) ( 4 ). Similarly, the long-term outcomes of the International Subarachnoid Aneurysm Trial (ISAT) revealed that patients in the EVT group were more likely to be alive and independent at 10 years than those in the MC group (OR 1.34, 95% CI 1.07–1.67) ( 33 ).…”

“…In previous comparative studies involving ruptured AComA aneurysms, procedural complications were not sufficiently characterized ( 4 , 5 , 13 , 14 , 17 , 28 ). In the post-BRAT study, Moon et al ( 3 ) reported only EVT-related complications, with major complications accounting for 3.2% and minor complications accounting for 7.5%.…”

“…In recent years, with the ongoing progress in interventional techniques and materials, anatomical factors have become less restrictive for EVT ( 3 ). EVT has been increasingly considered a preferred option for ruptured AComA aneurysms ( 4 ). However, the existing evidence is insufficient to demonstrate the clear superiority of EVT in terms of safety and efficacy.…”

Microsurgical clipping of anterior communicating artery aneurysms as a method of prevention of repeated aneurysm rupture

“…Нині для лікування аневризм передньої сполучної артерії розроблено кілька нових хірургічних підходів [6,[11][12][13]:…”