Ahmad Sweid1, Kareem El Naamani1, Rawad Abbas1, Robert M Starke2, Khodr Badih3, Rayan El Hajjar4, Hassan Saad5, Bassel Hammoud6, Carrie Andrews1, Sage P Rahm7, Elias Atallah1, Sunidhi Ramesh1, Stavropoula Tjoumakaris1, M Reid Gooch1, Nabeel Herial1, David Hasan8,9, Robert H Rosenwasser1, Pascal Jabbour1. 1. Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. 2. Department of Neurosurgery, University of Miami Hospital, Miami, Florida, USA. 3. Department of Physics, University of Toronto, Toronto, Ontario, Canada. 4. Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. 5. Department of Neurosurgery, Emory University, Atlanta, Georgia, USA. 6. Department of Biomedical Engineering, American University of Beirut, Beirut, Lebanon. 7. Department of Neurosurgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA. 8. Department of Neurosurgery, University of Iowa, Iowa City, Iowa, USA. 9. Department of Neurosurgery, Duke University, Durham, North Carolina, USA.
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.
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: Mathew P Cherian; M B Pranesh; Pankaj Mehta; K Vijayan; P Baskar; Tejas M Kalyanpur; Kaustubh S Narsinghpura Journal: Neurol India Date: 2011 Mar-Apr Impact factor: 2.117
Authors: S Finitsis; R Anxionnat; A Lebedinsky; P C Albuquerque; M F Clayton; L Picard; S Bracard Journal: Interv Neuroradiol Date: 2010-03-25 Impact factor: 1.610
Authors: Jean Raymond; François Guilbert; Alain Weill; Stavros A Georganos; Louis Juravsky; Anick Lambert; Julie Lamoureux; Miguel Chagnon; Daniel Roy Journal: Stroke Date: 2003-05-29 Impact factor: 7.914
Authors: Andrew Kelly Johnson; Stephan A Munich; Daniel M Heiferman; Demetrius Klee Lopes Journal: J Neurointerv Surg Date: 2012-09-21 Impact factor: 5.836
Authors: S Claiborne Johnston; Christopher F Dowd; Randall T Higashida; Michael T Lawton; Gary R Duckwiler; Daryl R Gress Journal: Stroke Date: 2007-11-29 Impact factor: 7.914
Authors: Andrew J Molyneux; Richard S C Kerr; Ly-Mee Yu; Mike Clarke; Mary Sneade; Julia A Yarnold; Peter Sandercock Journal: Lancet Date: 2005 Sep 3-9 Impact factor: 79.321