Predictors of Ischemic Complication in Anterior Choroidal Artery Aneurysm Repair.

Document Type

Article

Abstract

BACKGROUND: Treatment of anterior choroidal artery (AchoA) aneurysms is challenging because of the risk of artery injury. The objective of the study was to evaluate the incidence and predictors of AchoA infarction in patients who underwent surgical or endovascular procedure.

METHODS: We included 123 patients with AchoA aneurysms treated by surgical clipping (n = 62; 50.4%) or endovascular coiling, including flow diverter placement (n = 61; 49.6%). The clinical and radiological data were retrospectively analyzed. AchoA infarction was defined as the presence of a hyperintense signal on diffusion-weighted imaging in the area of AchoA, including the posterior limb of the internal capsule.

RESULTS: AchoA infarction was detected in 8 cases (6.5%), with similar incidence in both groups (6.5% [4/62] vs. 6.6% [4/61]). It occurred in ruptured aneurysms more frequently than in unruptured aneurysms (14.3% [6/42] vs. 2.5% [2/81], P = 0.019). In the surgical group, all 4 affected patients had a non-proximal type AchoA, whereas in the non-infarction group, 9 patients (15.5%) had a non-proximal type AchoA (P = 0.001). In the endovascular group, the incidence was higher in patients with ruptured aneurysms (17.3% [4/23] vs. 0% [0/38], P = 0.017) and lower in patients with pre-admission antiplatelet therapy (0% [0/39] vs. 18.8% [4/22], P = 0.014).

CONCLUSIONS: Repair of an AchoA aneurysm is associated with the risk of incurring post-procedural AchoA infarction. Surgical clipping and endovascular coiling have similar complication rates, but risk factors specific to each intervention exist. Careful surgical planning to avoid these risk factors in each therapeutic modality may improve patient outcomes.

Keywords

Humans, Intracranial Aneurysm, Retrospective Studies, Treatment Outcome, Endovascular Procedures, Cerebral Arteries, Embolization, Therapeutic, Aneurysm, Ruptured

Medical Subject Headings

Humans; Intracranial Aneurysm; Retrospective Studies; Treatment Outcome; Endovascular Procedures; Cerebral Arteries; Embolization, Therapeutic; Aneurysm, Ruptured

Publication Date

11-1-2022

Publication Title

World Neurosurg

ISSN

1878-8769

Volume

167

First Page

157

Last Page

157

PubMed ID

35934295

Digital Object Identifier (DOI)

10.1016/j.wneu.2022.07.111

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