Angiographic and clinical results of anterior communicating artery aneurysm endovascular treatment

Abstract

Introduction The anterior communicating artery (ACoA) is the most common location of intracranial aneurysms, observed in 35% of cases. Endovascular treatment has become an alternative to surgical clipping and the primary method of choice. Aim To assess the treatment results of ruptured and unruptured ACoA aneurysms and to assess the incidence of intraprocedural complications and various factors influencing these aspects. Material and methods One hundred and eleven embolizations of ACoA aneurysms (80.7% ruptured and 19.3% unruptured) were retrospectively analysed. The methods of embolization were: coiling, balloon-assisted coiling, stent-assisted coiling. Morphology and dimensions of aneurysms were assessed on 3D digital subtraction angiography (DSA) images. Medical records were analysed for patient’s clinical status at admission, intraprocedural complications, follow-up examination and modified Rankin Scale (mRS) score 1 month after discharge. Results Immediately after the procedure 56.9% of patients had Raymond-Roy Occlusion Classification (RROC) class I, 37.6% class II and 5.5% class III. The overall intraprocedural complication rate was 6.6%. There were significantly more cases of bleeding (p = 0.012) and coil prolapse (p = 0.012) during the procedures ending with higher packing density. Twenty-eight (25.7%) patients died during hospital stay, 27 (96.4%) with ruptured aneurysm. In the follow-up of 41 patients, RROC was the same or improved in 73.2% of cases and recanalization occurred in 26.8%. Six patients with aneurysm recanalization underwent repeat embolization. Conclusions Endovascular embolization of ACoA aneurysms is an effective and safe treatment method. The most powerful factor influencing the incidence of complications is packing density. Superior orientation of the dome, initial incomplete embolization and poor outcome in mRS scale are factors predisposing to ACoA aneurysm recurrence.