Endovascular treatment of 306 anterior communicating artery aneurysms: overall, perioperative results

Clinical article

Guido Guglielmi Division of Interventional Neuroradiology, University of California at Los Angeles, California; and
Division of Neuroradiology, San Camillo Hospital, Rome, Italy

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 M.D.
,
Fernando Viñuela Division of Interventional Neuroradiology, University of California at Los Angeles, California; and

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 M.D.
,
Gary Duckwiler Division of Interventional Neuroradiology, University of California at Los Angeles, California; and

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 M.D.
,
Reza Jahan Division of Interventional Neuroradiology, University of California at Los Angeles, California; and

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 M.D.
,
Enrico Cotroneo Division of Neuroradiology, San Camillo Hospital, Rome, Italy

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 M.D.
, and
Renato Gigli Division of Neuroradiology, San Camillo Hospital, Rome, Italy

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 M.D.
Page Range:
874–879
Volume/Issue:
Volume 110: Issue 5
DOI link:
https://doi.org/10.3171/2008.10.JNS081005
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Object

A series of 306 consecutive patients with an anterior communicating artery (ACoA) aneurysm is presented. The goal in this study was to report the results of endovascular treatment of ACoA aneurysms in these patients.

Methods

The aneurysms were managed with an endovascular approach in which detachable coils were used. A brief anatomical description of the ACoA and its branches as well as a review of the surgical and endovascular literature is presented. The “ACoA Syndrome” (that is, amnesia and personality changes), which may occur after subarachnoid hemorrhage, is briefly reviewed and described. Recent technical developments that can lead to improved results are also discussed.

Results

Of the 306 aneurysms, 268 (87.5%) were small, 30 (10%) were large, and 8 (2.6%) were giant. One hundred ninety-three aneurysms (63%) had a small neck, whereas 113 (37%) had a wide neck. Sixty-five lesions (21%) were incidental, 5 (2%) presented with symptoms of mass effect, and 236 (77%) presented with a subarachnoid hemorrhage. A complete aneurysm occlusion was attained in 139 cases (45.5%), a neck remnant was detected in 145 (47.5%), and in 22 cases (7%) a residual filling of the aneurysm was observed. Regarding the clinical neurological outcome, 280 patients (91.5%) remained neurologically intact, improved, or unchanged from their initial clinical status. Two large, wide-necked, subtotally occluded aneurysms ruptured 3–7 months after the procedure, with subsequent death of the patients. The procedure-related morbidity and mortality rates were 3.5% (11 cases) and 1% (3 cases), respectively.

Conclusions

The inherently lower risk of injuring or occluding the delicate branches and perforating vessels arising from the ACoA makes the endovascular approach attractive, interesting, and elegant.

Abbreviations used in this paper:

ACoA = anterior communicating artery; GDC = Guglielmi detachable coil.
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Contributor Notes

Address correspondence to: Guido Guglielmi, M.D., Piazza Mazzini, 27 00195 Rome, Italy. email: guidogdc@yahoo.com.
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