PDF herunterladen
CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(03): 522-527
DOI: 10.1055/s-0043-1771316
Original Article

Endovascular Treatment of Anterior Communicating Artery Aneurysms: A Single-Center Experience from a Developing Country

Sajjad Saghebdoust
1   Department of Neurosurgery, Section of Neurovascular Intervention, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
2   Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
3   Department of Neurosurgery, Razavi Hospital, Mashhad, Iran
,
Amir Reza Barani
2   Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
,
Mohammad Ali Abouei Mehrizi
2   Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
,
Mehran Ekrami
2   Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
,
Amir Valinezhad Lajimi
2   Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
,
Gholamreza Termechi
4   Department of Neurology, Vali-e-Asr Hospital, Tehran, Iran
› Institutsangaben Funding None.
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Objective In recent years, endovascular methods have been developed to treat intracranial aneurysms. To date, results of endovascular treatment (EVT) for anterior communicating aneurysms (ACoAs) have never been investigated in Iran. Thus, we sought to assess the mid-term angiographic and clinical outcomes of patients with ACoAs who underwent EVT in a tertiary center.

Materials and Methods Electronic health documents of patients with ACoAs who underwent EVT from March 2019 to July 2021 were retrospectively reviewed. Demographic and clinical characteristics of patients, procedural and clinical complications along with immediate and 12 months' postprocedural angiographic and clinical results were included in the analysis. Aneurysm occlusion status was classified based on the Raymond–Roy Occlusion Classification (RROC), and clinical outcomes were assessed using the modified Rankin Scale (mRS).

Results Of 38 patients with 38 ACoAs, 32 patients (84.21%) presented with subarachnoid hemorrhage of whom 23 (60.52%) had ruptured ACoAs. EVT included simple coiling in 29 patients (76.32%), balloon-assisted coiling in 6 (15.79%), and stent-assisted coiling in 3 (7.89%). Immediate and 12-month postprocedural angiograms demonstrated complete/near-complete occlusion (RROC I and II) in 32 (84.21%) and 35 patients (97.22%), respectively. Periprocedural complications occurred in five patients (13.15%), and the mortality rate was 5.26%. Thirty-two patients (84.21%) had favorable outcomes (mRS 0–2) at the last follow-up.

Conclusion EVT is a safe and beneficial procedure with favorable mid-term clinical and angiographic outcomes for ACoAs. Our results can lay the foundation for further studies in developing countries and are satisfactory enough for neurointerventionists to put EVT on the therapeutic agenda of ACoAs.

Keywords

anterior communicating artery - endovascular treatment - intracranial aneurysm - clinical outcome - angiographic outcome

Ethics Approval

This study was approved by our institutional ethics committee with the ethical code number: IR.BMSU.REC.1401.008.


Informed Consent

Written informed consent was obtained from patients for the publication of this paper.


Authors' Contributions

S.S. contributed to writing the paper, data collection, interpretation, and leadership responsibility for the research activity planning and execution, including mentorship external to the core team. A.R.B., M.E., and M.A.A.M. contributed to data collection and interpretation. A.V.L. and G.T. contributed to the study concept or design and interpretation.




Publikationsverlauf

Artikel online veröffentlicht:
22. September 2023

© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Keedy A. An overview of intracranial aneurysms. McGill J Med 2006; 9 (02) 141-146
    PubMedSuche in Google Scholar
  • 2 Fang S, Brinjikji W, Murad MH, Kallmes DF, Cloft HJ, Lanzino G. Endovascular treatment of anterior communicating artery aneurysms: a systematic review and meta-analysis. AJNR Am J Neuroradiol 2014; 35 (05) 943-947
    CrossrefPubMedSuche in Google Scholar
  • 3 Molyneux A, Kerr R, Stratton I. et al; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized trial. J Stroke Cerebrovasc Dis 2002; 11 (06) 304-314
    CrossrefPubMedSuche in Google Scholar
  • 4 Guglielmi G, Vinuela F, Sepetka I, Macellari V, Kerr RS. Electrothrombosis of saccular aneurysms via endovascular approach: part 1: electrochemical basis, technique, and experimental results. Journal of Neurosurgery 1991; 75 (01) 1-7
    CrossrefPubMedSuche in Google Scholar
  • 5 De Leacy RA, Fargen KM, Mascitelli JR. et al. Wide-neck bifurcation aneurysms of the middle cerebral artery and basilar apex treated by endovascular techniques: a multicentre, core lab adjudicated study evaluating safety and durability of occlusion (BRANCH). J Neurointerv Surg 2019; 11 (01) 31-36
    CrossrefPubMedSuche in Google Scholar
  • 6 Yarahmadi P, Kabiri A, Bavandipour A, Jabbour P, Yousefi O. Intra-procedural complications, success rate, and need for retreatment of endovascular treatments in anterior communicating artery aneurysms: a systematic review and meta-analysis. Neurosurg Rev 2022; 45 (05) 3157-3170
    CrossrefPubMedSuche in Google Scholar
  • 7 Moon K, Albuquerque FC, Ducruet AF, Crowley RW, McDougall CG. Balloon remodeling of complex anterior communicating artery aneurysms: technical considerations and complications. J Neurointerv Surg 2015; 7 (06) 418-424
    CrossrefPubMedSuche in Google Scholar
  • 8 Moon K, Park MS, Albuquerque FC, Levitt MR, Mulholland CB, McDougall CG. Changing paradigms in the endovascular management of ruptured anterior communicating artery aneurysms. Neurosurgery 2017; 81 (04) 581-584
    CrossrefPubMedSuche in Google Scholar
  • 9 Sano H, Satoh A, Murayama Y. et al; members of the 38 registered institutions and WFNS Cerebrovascular Disease & Treatment Committee. Modified World Federation of Neurosurgical Societies subarachnoid hemorrhage grading system. World Neurosurg 2015; 83 (05) 801-807
    CrossrefPubMedSuche in Google Scholar
  • 10 Frontera JA, Claassen J, Schmidt JM. et al. Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale. Neurosurgery 2006; 59 (01) 21-27 , discussion 21–27
    PubMedSuche in Google Scholar
  • 11 Vivanco-Suarez J, Wallace AN, Dandapat S. et al. Stent-assisted coiling versus balloon-assisted coiling for the treatment of ruptured wide-necked aneurysms: a 2-center experience. Stroke Vasc Intervent Neurol 2023; 3 (01) e000456
    CrossrefSuche in Google Scholar
  • 12 Zhao B, Yin R, Lanzino G, Kallmes DF, Cloft HJ, Brinjikji W. Endovascular coiling of wide-neck and wide-neck bifurcation aneurysms: a systematic review and meta-analysis. AJNR Am J Neuroradiol 2016; 37 (09) 1700-1705
    CrossrefPubMedSuche in Google Scholar
  • 13 Wallace AN, Samaniego E, Kayan Y. et al. Balloon-assisted coiling of cerebral aneurysms with the dual-lumen Scepter XC balloon catheter: experience at two high-volume centers. Interv Neuroradiol 2019; 25 (04) 414-418
    CrossrefPubMedSuche in Google Scholar
  • 14 Chalouhi N, Jabbour P, Singhal S. et al. Stent-assisted coiling of intracranial aneurysms: predictors of complications, recanalization, and outcome in 508 cases. Stroke 2013; 44 (05) 1348-1353
    CrossrefPubMedSuche in Google Scholar
  • 15 Mascitelli JR, Moyle H, Oermann EK. et al. An update to the Raymond-Roy Occlusion Classification of intracranial aneurysms treated with coil embolization. J Neurointerv Surg 2015; 7 (07) 496-502
    CrossrefPubMedSuche in Google Scholar
  • 16 Hernesniemi J, Dashti R, Lehecka M. et al. Microneurosurgical management of anterior communicating artery aneurysms. Surg Neurol 2008; 70 (01) 8-28 , discussion 29
    CrossrefPubMedSuche in Google Scholar
  • 17 Liu J, Song J, Zhao D. et al. Risk factors responsible for the volume of hemorrhage in aneurysmal subarachnoid hemorrhage. Neurol India 2016; 64 (04) 686-691
    CrossrefPubMedSuche in Google Scholar
  • 18 Limbucci N, Leone G, Renieri L. et al. Expanding indications for flow diverters: distal aneurysms, bifurcation aneurysms, small aneurysms, previously coiled aneurysms and clipped aneurysms, and carotid cavernous fistulas. Neurosurgery 2020; 86 (Suppl. 01) S85-S94
    CrossrefPubMedSuche in Google Scholar
  • 19 Fan L, Lin B, Xu T. et al. Predicting intraprocedural rupture and thrombus formation during coiling of ruptured anterior communicating artery aneurysms. J Neurointerv Surg 2017; 9 (04) 370-375
    CrossrefPubMedSuche in Google Scholar
  • 20 Finitsis S, Anxionnat R, Lebedinsky A. et al. Endovascular treatment of ACom intracranial aneurysms. Report on series of 280 patients. Interv Neuroradiol 2010; 16 (01) 7-16
    CrossrefPubMedSuche in Google Scholar
  • 21 Moret J, Pierot L, Boulin A, Castaings L, Rey A. Endovascular treatment of anterior communicating artery aneurysms using Guglielmi detachable coils. Neuroradiology 1996; 38 (08) 800-805
    CrossrefPubMedSuche in Google Scholar
  • 22 Catapano JS, Karahalios K, Rumalla K. et al. Endovascular treatment of ruptured anterior communicating aneurysms: a 17-year institutional experience with coil embolization. J Neurointerv Surg 2022; 14 (10) 1018-1021
    CrossrefPubMedSuche in Google Scholar
  • 23 Elias T, Ogungbo B, Connolly D, Gregson B, Mendelow AD, Gholkar A. Endovascular treatment of anterior communicating artery aneurysms: results of clinical and radiological outcome in Newcastle. Br J Neurosurg 2003; 17 (03) 278-286
    CrossrefPubMedSuche in Google Scholar
  • 24 Turjman F, Massoud TF, Sayre J, Viñuela F. Predictors of aneurysmal occlusion in the period immediately after endovascular treatment with detachable coils: a multivariate analysis. AJNR Am J Neuroradiol 1998; 19 (09) 1645-1651
    PubMedSuche in Google Scholar
  • 25 Tarulli E, Sneade M, Clarke A, Molyneux AJ, Fox AJ. Effects of circle of Willis anatomic variations on angiographic and clinical outcomes of coiled anterior communicating artery aneurysms. AJNR Am J Neuroradiol 2014; 35 (08) 1551-1555
    CrossrefPubMedSuche in Google Scholar
  • 26 Brzegowy P, Kucybała I, Krupa K. et al. Angiographic and clinical results of anterior communicating artery aneurysm endovascular treatment. Wideochir Inne Tech Malo Inwazyjne 2019; 14 (03) 451-460
    PubMedSuche in Google Scholar
  • 27 Harris L, Hill CS, Elliot M, Fitzpatrick T, Ghosh A, Vindlacheruvu R. Comparison between outcomes of endovascular and surgical treatments of ruptured anterior communicating artery aneurysms. Br J Neurosurg 2021; 35 (03) 313-318
    CrossrefPubMedSuche in Google Scholar
  • 28 Cherian MP, Pranesh MB, Mehta P. et al. Outcomes of endovascular coiling of anterior communicating artery aneurysms in the early post-rupture period: a prospective analysis. Neurol India 2011; 59 (02) 218-223
    CrossrefPubMedSuche in Google Scholar
  • 29 Hur CW, Choi CH, Cha SH, Lee TH, Jeong HW, Lee JI. Eleven year's single center experience of endovascular treatment of anterior communicating artery aneurysms: Focused on digital subtraction angiography follow-up results. J Korean Neurosurg Soc 2015; 58 (03) 184-191
    CrossrefPubMedSuche in Google Scholar
  • 30 Kocur D, Zbroszczyk M, Przybyłko N. et al. Stand-alone coil embolization of anterior communicating artery aneurysms: efficacy and technical issues. Neuroradiol J 2016; 29 (05) 361-367
    CrossrefPubMedSuche in Google Scholar
  • 31 Debono B, Proust F, Langlois O. et al. Ruptured anterior communicating artery aneurysm. Therapeutic options in 119 consecutive cases [in French]. Neurochirurgie 2004; 50 (01) 21-32
    PubMedSuche in Google Scholar
  • 32 Soares FP, Velho MC, Antunes ACM. Clinical and morphological profile of aneurysms of the anterior communicating artery treated at a neurosurgical service in Southern Brazil. Surg Neurol Int 2019; 10: 193
    CrossrefPubMedSuche in Google Scholar
  • 33 Jang CK, Chung J, Lee JW, Huh SK, Son N-H, Park KY. Recurrence and retreatment of anterior communicating artery aneurysms after endovascular treatment: a retrospective study. BMC Neurol 2020; 20 (01) 287
    CrossrefPubMedSuche in Google Scholar