Comparison between outcomes of endovascular and surgical treatments of ruptured anterior communicating artery aneurysms

Abstract

The natural history and optimal treatment of previously ruptured anterior communicating artery (ACOM) aneurysms that recur is unknown. This study looks at rates of complications and recurrences of ruptured ACOM aneurysms treated endovascularly and surgically. Materials and methodsA retrospective observational study of all patients presenting to a single tertiary neurosurgical centre with the first presentation of subarachnoid haemorrhage (SAH) secondary to a ruptured ACOM aneurysm. Data was collected from November 2012 to September 2018 and included baseline demographics, aneurysm characteristics, management, complications, follow-up imaging, and clinical outcomes. Results137 patients were included in the study. 113 aneurysms were coiled and 19 were clipped.Management decisions were taken by the multidisciplinary team based on aneurysm morphology or the presence of a haematoma exerting mass effect. There were 187.5 patientyears of follow-up, with a median of 3 years (range 0-73 months). Rates of vasospasm, infarction, CSF diversion, rebleed, length of stay, and functional outcome were not significantly different in the two cohorts. There was a statistically significant increase in the risk of ACOM recurrence in the coiled group when compared to the clipped group at one year (p = 0.0433). 15 patients required further treatment at a median time of 16 months. In a

Economic and Humanistic Burden of Cerebral Vasospasm and Its Related Complications after Aneurysmal Subarachnoid Hemorrhage: A Systematic Literature Review

“…Forty studies were conducted in single countries: 20 studies in the USA [ 11 , 26 , 30 , 36 , 39 , 41 – 44 , 46 – 48 , 52 , 56 , 58 – 60 , 63 – 65 ], and the remainder in Australia [ 49 ], Brazil [ 29 ], Canada [ 35 ], China [ 31 ], Estonia [ 24 ], Finland [ 50 ], Germany [ 40 , 53 , 54 ], India [ 28 ], Japan [ 33 ], New Zealand [ 51 ], Poland [ 61 ], Portugal [ 57 ], Turkey [ 37 , 38 ], and the UK [ 32 , 45 , 55 , 62 ]. Two RCTs were conducted in multiple countries: the CONSCIOUS-1 trial [ 27 ] in Austria, Canada, Finland, France, Germany, Israel, Italy, Sweden, Switzerland, the UK, and the USA, and another trial [ 34 ] in Canada, the Netherlands, and the USA.…”

“…The longest study was a retrospective cohort analysis of cost drivers for aneurysms using the US Value Driven Outcomes database, which reported data from a 15.5-year period (July 2001 to January 2017) [ 63 ]. Two RCTs [ 30 , 31 ] and 13 observational studies [ 35 – 38 , 40 – 42 , 45 , 46 , 52 , 56 , 59 , 63 ] collected data after 2010.…”

“…Of the 18 studies that reported baseline Fisher grade, 14 studies [ 28 – 30 , 32 , 33 , 39 , 40 , 43 , 45 , 53 , 59 , 60 , 63 , 65 ] included a patient population with high disease severity, with most patients falling into the Fisher grade 3 category, which has the highest risk for VSP, DCI, and resulting poor outcomes [ 66 ]. Approximately two-thirds or more of patients from 18 studies [ 24 , 26 , 28 – 30 , 34 , 36 , 38 , 40 , 43 , 48 , 50 , 54 , 59 – 61 , 63 , 65 ] had a Hunt–Hess baseline score of ≤ 3 at hospital entry, corresponding to asymptomatic or minimal headache (grade 1), moderate-to-severe headache (grade 2), or drowsiness, confusion, or mild focal deficit (grade 3).…”

“…Additionally, around half or more of patients from 4 studies [ 11 , 39 , 53 , 55 ] had a Hunt–Hess baseline score of ≥ 3 at hospital entry (grade 4 = stupor, moderate to severe hemiparesis; grade 5 = deep coma). Similarly, patient baseline World Federation of Neurosurgical Societies (WFNS) grade varied considerably across the studies, from grade 1 (fully awake) to grade 4 and 5 (highest severity, with or without focal deficit) across 8 studies [ 27 , 32 , 38 , 40 , 45 , 53 , 55 , 61 ], baseline modified Rankin scale (mRS) scores varied from no disability to severe disability across six studies [ 24 , 30 , 33 , 48 , 57 , 61 ], and baseline GCS scores ranging from 3 (no responsiveness) to 15 (highest responsiveness) were reported across 4 RTCs [ 26 , 27 , 30 , 31 ] and 10 observational studies [ 37 , 38 , 44 , 51 , 53 , 55 , 56 , 59 , 60 , 64 ].…”

Plasma Amino Acids May Improve Prediction Accuracy of Cerebral Vasospasm after Aneurysmal Subarachnoid Haemorrhage

“…The new recommendation endorses endovascular coiling in the elderly, poor-grade aSAH, and aneurysms of the basilar tip [9]. Still, it is recommended that treatment decisions be made together with the patient, after receiving recommendations from the multidisciplinary team [10].…”