Endovascular treatment of ruptured anterior communicating aneurysms: a 17-year institutional experience with coil embolization

Authors

Joshua S. Catapano, Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Katherine Karahalios, Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Kavelin Rumalla, Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Visish M. Srinivasan, Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Caleb Rutledge, Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Jacob F. Baranoski, Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Tyler S. Cole, Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Ashutosh P. Jadhav, Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Andrew F. Ducruet, Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Felipe C. Albuquerque, Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA Felipe.Albuquerque@barrowbrainandspine.com.Follow

Document Type

Article

Abstract

BACKGROUND: Ruptured anterior communicating artery (ACoA) aneurysms can be challenging to treat via an endovascular procedure. This study analyzed retreatment rates and neurological outcomes associated with ruptured ACoA aneurysms treated via endovascular coiling. METHODS: All patients with a ruptured ACoA aneurysm treated with endovascular coiling from 2003 to 2019 were retrospectively analyzed at a single center. Two comparisons were performed: no retreatment versus retreatment and coil embolization versus balloon-assisted coil embolization. Outcomes included retreatment and neurological outcome assessed via modified Rankin Scale (mRS). RESULTS: During the study period, 186 patients with ruptured ACoA aneurysms underwent coil embolization. Treatment included standard coil embolization (68.3%, n=127), balloon-assisted coiling (28.5%, n=53), and stent-assisted embolization (2.7%, n=5). Angiographic outcomes were as follows: class I, 65.1% (n=121); class II, 28.5% (n=53); and class III, 6.5% (n=12). There were no aneurysm reruptures after the index procedure. The mean (SD) mRS score was 2.7 (2.0) at last follow-up (mortality, 19 (10%)). Retreatment occurred in 9.7% (n=18). Patients with retreatment were younger with lower-grade subarachnoid hemorrhage and more favorable functional status at discharge. Patients with aneurysms >7 mm (n=36) were significantly more likely to have recurrence (22.2% vs 6.7%, P=0.005). CONCLUSIONS: Endovascular treatment of ruptured ACoA aneurysms is safe and is associated with low mortality and retreatment rates. Younger patients with favorable functional status and larger aneurysm size are more likely to be retreated. Ruptured aneurysms <4 mm, although prevalent in the study (29%), never required retreatment.

Keywords

aneurysm, angiography, coil

Medical Subject Headings

Adult; Aneurysm, Ruptured (diagnostic imaging, etiology, therapy); Cerebral Angiography; Child; Embolization, Therapeutic (methods); Endovascular Procedures (methods); Humans; Intracranial Aneurysm (diagnostic imaging, etiology, therapy); Retrospective Studies; Stents (adverse effects); Treatment Outcome

Publication Date

10-1-2022

Publication Title

Journal of neurointerventional surgery

E-ISSN

1759-8486

Volume

14

Issue

10

First Page

1018

Last Page

1021

PubMed ID

34615688

Digital Object Identifier (DOI)

10.1136/neurintsurg-2021-017695

Recommended Citation

Catapano, Joshua S.; Karahalios, Katherine; Rumalla, Kavelin; Srinivasan, Visish M.; Rutledge, Caleb; Baranoski, Jacob F.; Cole, Tyler S.; Jadhav, Ashutosh P.; Ducruet, Andrew F.; and Albuquerque, Felipe C., "Endovascular treatment of ruptured anterior communicating aneurysms: a 17-year institutional experience with coil embolization" (2022). Translational Neuroscience. 2255.
https://scholar.barrowneuro.org/neurobiology/2255