Safety and efficacy of anterior communicating artery compromise during endovascular coil embolization of adjoining aneurysms

Hyun Ho Choi MD1, Young Dae Cho MD, PhD2, Dong Hyun Yoo MD2, Su Hwan Lee MD3, Eung Koo Yeon MD2, Hyun-Seung Kang MD, PhD3, Won-Sang Cho MD, PhD3, Jeong Eun Kim MD, PhD3, and Moon Hee Han MD, PhD2,3
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  • 1 Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul;
  • | 2 Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul; and
  • | 3 Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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OBJECTIVE

In the presence of symmetric A1 flow, the safety and efficacy of compromising the anterior communicating artery (ACoA) during coil embolization of ACoA aneurysms has yet to be evaluated. Herein, the authors describe their experience, focusing on procedural safety.

METHODS

Between October 2012 and July 2017, 285 ACoA aneurysms with symmetric A1 flows were treated at the authors’ institution by endovascular coil embolization. Clinical and angiographic outcome data were subjected to binary logistic regression analysis.

RESULTS

ACoA compromise was chosen in the treatment of 71 aneurysms (24.9%), which were completely (n = 15) or incompletely (n = 56) compromised. In the remaining 214 lesions, the ACoA was preserved. Although 9 patients (3.2%) experienced procedure-related thromboembolisms (compromised, 4; preserved, 5), all but 1 patient (with ACoA compromise) were asymptomatic. In multivariate analysis, subarachnoid hemorrhage at presentation was the sole independent risk factor for thromboembolism (OR 15.98, p < 0.01), with ACoA compromise being statistically unrelated. In 276 aneurysms (96.8%) with follow-up of > 6 months (mean 20.9 ± 13.1 months, range 6–54 months), recanalization was confirmed in 21 (minor, 15; major, 6). A narrow (≤ 4 mm) saccular neck (p < 0.01) and ACoA compromise (p = 0.04) were independently linked to prevention of recanalization.

CONCLUSIONS

During coil embolization of ACoA aneurysms, the ACoA may be compromised without serious complications if A1 flows are symmetric. This approach may also confer some long-term protection from recanalization, serving as a valid treatment option for such lesions.

ABBREVIATIONS

ACoA = anterior communicating artery; DSA = digital subtraction angiography; mRS = modified Rankin Scale; PCoA = posterior communicating artery; SAH = subarachnoid hemorrhage; UIA = unruptured intracranial aneurysm.

Supplementary Materials

    • Supplemental Table 1 (PDF 409 KB)

Illustration from Duan et al. (pp 1174–1181).

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Contributor Notes

Correspondence Young Dae Cho: Seoul National University College of Medicine, Seoul, Korea. aronnn@naver.com.

INCLUDE WHEN CITING Published online March 1, 2019; DOI: 10.3171/2018.11.JNS181929.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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