Clipping Could Be the Best Treatment Modality for Recurring Anterior Communicating Artery Aneurysms Treated Endovascularly.
Publication/Presentation Date
5-1-2022
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.
Volume
90
Issue
5
First Page
627
Last Page
635
ISSN
1524-4040
Published In/Presented At
Sweid, A., El Naamani, K., Abbas, R., Starke, R. M., Badih, K., El Hajjar, R., Saad, H., Hammoud, B., Andrews, C., Rahm, S. P., Atallah, E., Ramesh, S., Tjoumakaris, S., Gooch, M. R., Herial, N., Hasan, D., Rosenwasser, R. H., & Jabbour, P. (2022). Clipping Could Be the Best Treatment Modality for Recurring Anterior Communicating Artery Aneurysms Treated Endovascularly. Neurosurgery, 90(5), 627–635. https://doi.org/10.1227/neu.0000000000001905
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
35285450
Department(s)
Administration and Leadership
Document Type
Article