Abstract
BackgroundSurgical treatment of anterior communicating artery (Acom) aneurysm is challenging due to anatomic complexity. We aimed to describe our experiences with endovascular treatment (EVT) of Acom aneurysms, and to evaluate the incidence and risk factors of recurrence and retreatment.MethodsThe study comprised 260 patients who were treated at a single center between January 2010 and December 2018. Patients who had EVT, including stent-assisted coiling of Acom aneurysms, were included. All medical records were retrospectively reviewed. The incidence and risk factors of recurrence and retreatment were evaluated. Univariate and multivariate analysis were conducted.ResultsRecurrence of Acom aneurysms occurred in 38 (14.6%) patients. Mean follow-up duration was 27 months (range 1–110). Multivariate logistic regression indicated that ruptured aneurysm (odds ratio [OR] 3.55, P = 0.001), dome direction (anterior) (OR 3.86, P = 0.002), maximal diameter (OR 1.19, P = 0.02), and mean age (OR 0.96, P = 0.02) were independent risk factors for aneurysm recurrence. Of 38 cases of recurrence, 10 (3.8%) patients underwent retreatment. Ruptured aneurysm (OR 14.7, P = 0.004), maximal diameter (OR 1.56, P = 0.02), inflow angle (OR 1.04, P = 0.03), and Raymond-Roy classes II and III (OR 6.19, P = 0.03) showed significant relation to retreatment in multivariate logistic regression analysis.ConclusionsIn our study, recurrence rate of Acom aneurysms after EVT was 14.6%. Rupture, anterior dome direction, maximal diameter, and mean age were significantly associated with recurrence. Retreatment rate of recurrent Acom aneurysms after EVT was 3.8%. Patients with Acom aneurysms with large inflow, rupture, large size, or incomplete occlusion may be at a high risk of retreatment of recurring aneurysm.
Highlights
Surgical treatment of anterior communicating artery (Acom) aneurysm is challenging due to anatomic complexity
Surgical clipping of Anterior communicating artery aneurysm (Acom) aneurysm sometimes require a dissection of the rectus gyrus or olfactory nerve
Age, rupture status, maximal diameter, size ratio, and dome direction were significant risk factors for recurrence
Summary
Surgical treatment of anterior communicating artery (Acom) aneurysm is challenging due to anatomic complexity. We aimed to describe our experiences with endovascular treatment (EVT) of Acom aneurysms, and to evaluate the incidence and risk factors of recurrence and retreatment. Anterior communicating artery (Acom) aneurysm has a higher risk of rupture than the other aneurysms [1]. Surgical treatment of Acom aneurysm is still challenging due to anatomic complexity. Acom aneurysm shows a variety of anomalies and complex anatomy like fenestrated, triplicated, and azygous anterior cerebral artery. It has many perforator and associated vessels such as the recurrent artery of Heubner, anterior lenticulostriate, and bilateral A1 and A2 arteries [2,3,4]. Surgical clipping of Acom aneurysm sometimes require a dissection of the rectus gyrus or olfactory nerve
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