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

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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.

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Article Information

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.

© AANS, except where prohibited by US copyright law.

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Figures

  • View in gallery

    Illustration of ACoA compromise. The coil occupies a segment of the ACoA adjoining saccular neck (A) and not the entire ACoA channel (B).

  • View in gallery

    Pre- (A) and postembolization (B) DS angiograms of a completely compromised ACoA during coil embolization (arrowheads). C and D: Postprocedural angiograms (right view, C; left view, D) showing bilateral A2 flow preservation through each A1 segment. Note that the ACoA flow originates from the contralateral A1 (arrow).

  • View in gallery

    Pre- (A) and postembolization (B) DS angiograms of an incompletely compromised ACoA during coil embolization (arrowheads). C and D: Postprocedural angiograms (left view, C; right view, D) confirming incomplete compromise of the ACoA, with bilateral A2 flow preservation.

  • View in gallery

    A and B: DS angiograms (left view, A; right view, B) showing an ACoA aneurysm with symmetric A1 flow. C: Coil embolization is undertaken to compromise the ACoA. D and E: Postprocedural angiograms (left view, D; right view, E) documenting bilateral A2 flow through each A1 segment after ACoA compromise. F: Postprocedural axial MR image confirming acute infarction of the corpus callosum (genu and rostrum).

  • View in gallery

    Kaplan-Meier estimates of cumulative survival without recanalization: aneurysm neck > 4 mm (A) and ACoA compromise (B). Figure is available in color online only.

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