Treatment results of endovascular surgery in the acute stage for ruptured anterior communicating artery aneurysms

Abstract

Background: There are few reports specifically evaluating endovascular surgery (endosaccular coil embolization) for acutely ruptured anterior communicating artery (ACoA) aneurysms. The objectives of this study were to evaluate the feasibility, safety, and efficacy of endovascular surgery in this setting. Methods: Incidents of endovascular surgery for acutely ruptured ACoA aneurysms were retrospectively reviewed from medical records to evaluate technical results, clinical outcomes and angiographic images. The clinical outcomes were recorded at discharge or transfer to other hospitals according to the Glasgow Outcome Scale. Immediate and follow-up angiographic results were categorized as complete occlusion (CO), residual neck (RN) or residual flow (RF). Failure of coil placement within the aneurysm after placing the guiding catheter was defined as attempted embolization. Angiographic changes during the follow-up period were categorized as: unchanged, minor recurrence, major recurrence, and progressive thrombosis. Results: Between August 2002 and June 2007, 82 patients with ruptured ACoA aneurysms were treated by endovascular surgery within 72 hours of the primary rupture. There were 49 females (59.8%) and mean age was 59.1 ± 12.3 years. The clinical outcomes of 77 endovascularly treated patients were good recovery and moderate disability in 68 (88.3%), severe disability/persistent vegetative state or dead in 9 (11.7%). Immediate angiographic outcomes demonstrated CO in 61 (74.4%), NR in 6 (7.3%) and RF in 10 (12.2%) patients. Attempted embolization occurred in 5 aneurysms (6.1%). Follow-up angiography (>3 months) was available for 56 patients and found to be unchanged in 32 (57.1%), minor recurrence in 14 (25%), major recurrence in 7 (12.5%), and progressive thrombosis in 3 (5.4%). Five aneurysms required 6 sessions of additional coil embolization due to a major recurrence. No patient that completed coil placement rebled from the treated aneurysm during the clinical follow-up period (mean, 16.8 mo). There were three procedural-related complications, all of which were intraoprative aneurysm ruptures (4.4%). One of them resulted in mortality, and the remaining 2 patients were asymptomatic. Conclusion: Endovascular surgery for acutely ruptured ACoA aneurysms can be performed with excellent clinical results and promises a decreasing risk of future aneurysmal bleeding. We believe that this modality can become a primary alternative to surgical clipping. © 2008, The Japanese Society for Neuroendovascular Therapy. All rights reserved.