Clipping Could Be the Best Treatment Modality for Recurring Anterior Communicating Artery Aneurysms Treated Endovascularly.

Abstract

BACKGROUND:

The anterior communicating artery (AcoA) is the most common location for intracranial aneurysms.

OBJECTIVE:

To present occlusion outcomes, complication rate, recurrence rate, and predictors of recurrence in a large cohort with AcoA aneurysms treated primarily with endosaccular embolization. We also attempt to present data on the most effective treatment modality for recurrent AcoA aneurysms.

METHODS:

This is a retrospective, single-center study, reviewing the outcomes of 463 AcoA aneurysms treated endovascularly between 2003 and 2018.

RESULTS:

The study cohort consisted of 463 patients. Adequate immediate occlusion was achieved in 418 (90.3%). Independent functional status at discharge was observed in 269 patients (58.0%), and the mortality rate was 6.8% (31). At 6 months, adequate occlusion was achieved in 418 (90.4%). Of all the patients, recurrence was observed in 101 cases (21.8%), and of those, 98 (22.4%) underwent retreatment. The combined frequency of retreatment for the coiling group was 42.4%, which was significantly higher than the 0 incident of retreatment in the clipping group (P < .0001). Among the retreatment cohort, there was a significantly higher subsequent retreatment rate in the endovascular group (0% in the clipping group vs 42.4% in the endovascular group, P < .0001).

CONCLUSION:

Coiling with and without stent/balloon assistance is a relatively safe and effective modality for the treatment of AcoA aneurysms; however, in the setting of recurrence, microsurgical reconstruction leads to improved outcomes regarding durable occlusion, thus avoiding the potential for multiple interventions in the future.

• Authors: Ahmad Sweid, Kareem El Naamani, Rawad Abbas, Robert M Starke, Khodr Badih, Rayan El Hajjar, Hassan Saad, Bassel Hammoud, Carrie Andrews, Sage P Rahm, Elias Atallah, Sunidhi Ramesh, Stavropoula Tjoumakaris, M Reid Gooch, Nabeel Herial, David Hasan, Robert H Rosenwasser, Pascal Jabbour
• Journal: Neurosurgery (Neurosurgery) Vol. 90 Issue 5 Pg. 627-635 (05 01 2022) ISSN: 1524-4040 [Electronic] United States
• PMID: 35285450 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

Topics

• Adult
• Child
• Embolization, Therapeutic
• Endovascular Procedures
• Humans
• Intracranial Aneurysm (surgery)
• Retrospective Studies
• Stents
• Treatment Outcome