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

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Sweid, A; El Naamani, K; Abbas, R; Starke, RM; Badih, K; El Hajjar, R; Saad, H; Hammoud, B; Andrews, C; Rahm, SP; Atallah, E; Ramesh, S; Tjoumakaris, S; Gooch, MR; Herial, N; Hasan, D; Rosenwasser, RH; Jabbour, P

Published Date

  • May 1, 2022

Published In

Volume / Issue

  • 90 / 5

Start / End Page

  • 627 - 635

PubMed ID

  • 35285450

Pubmed Central ID

  • PMC9514745

Electronic International Standard Serial Number (EISSN)

  • 1524-4040

Digital Object Identifier (DOI)

  • 10.1227/neu.0000000000001905

Language

  • eng

Conference Location

  • United States