Endovascular treatment of complicated ruptured anterior communicating artery aneurysms based on the anatomical features of the anterior communicating artery complex

Abstract

Endovascular therapy of complicated ruptured anterior communicating artery (ACoA) aneurysms is difficult due to their small size and unfavorable shape. Based on the anatomical features of the ACoA complex, we investigated the feasibility and efficacy of different coil embolism strategies for complicated ACoA aneurysms. Sixteen patients with complicated ruptured ACoA aneurysms received endovascular treatment. Aneurysm sac plus ACoA embolism or ACoA coil embolism were performed if the bilateral A1 segment was normally developed or unilateral A1 segment dysplasia (≥1/2 normal contralateral diameter) was present. Where unilateral A1 segment dysplasia (<1/2 normal contralateral diameter) or aplasia was present, sac embolism alone was performed. Follow-up angiography was performed, and clinical follow-up data were categorized as fully recovered, improved, unchanged or worsened. Aneurysm sac plus ACoA (n=5) or ACoA alone (n=2) coil embolism was performed in seven patients with normal bilateral A1 segments (n=5) or dysplasia (n=2). Sac coil embolism was performed in nine patients with unilateral A1 segment dysplasia (n=1) or aplasia (n=8). Immediate angiography indicated total/near-total occlusion was achieved in 14 patients. Final angiographic (mean 11.9 ± 5.1 months) and clinical (mean 17.7 ± 5.9 months) follow-up confirmed total/near-total occlusion in 12 patients, one partial occlusion, two enlarged residual sacs and one reopened aneurysm. Clinical symptoms fully recovered in 10 patients, improved in four, were unchanged in one and worsened in one patient. This small middle-term follow-up study demonstrates coil embolism endovascular treatment of complicated ruptured ACoA aneurysms, based on the anatomical features of the ACoA complex, is feasible and effective.