Endovascular Treatment of Anterior Communicating Artery Aneurysms: A Systematic Review and Meta-Analysis

Abstract

BACKGROUND AND PURPOSE: Endovascular therapy has become an acceptable alternative to traditional clipping for the management of intracranial aneurysms. However, a limited number of studies have examined outcomes and complications specific to embolization of anterior communicating artery aneurysms.

Predicting intraprocedural rupture and thrombus formation during coiling of ruptured anterior communicating artery aneurysms

“…These results are consistent with previous studies showing an intraprocedural rupture rate of 4.1% in ruptured aneurysms,5 7 8 and a thromboembolic complication rate ranging from 4.7% to 12.5% 3 15 16. Despite advances in endovascular technology, intraprocedural rupture and thrombus formation remain common during coiling of ruptured ACoA aneurysms, probably because aggressive coiling of ruptured aneurysms to achieve tighter packing increases the risk.…”

Effects of Circle of Willis Anatomic Variations on Angiographic and Clinical Outcomes of Coiled Anterior Communicating Artery Aneurysms

“…This factor alone could explain the differences between our study and the recent meta-analysis by Fang et al 16 Interestingly, the largest sources of data heterogeneity cited in the meta-analysis were angiographic outcomes immediately after coiling and in long-term follow-up.…”

“…16 If the same definition were applied to our study, combining complete and neck remnants to be equivalent to "complete and near complete occlusions," the immediate postcoiling success rates are comparable at 85% and 88% for the A1 codominant and A1 dominant AcomA aneurysms, respectively. At the follow-up, however, this drops to 77% and 76%, and applying the CCT trial definition of success at follow-up, the rate further reduces to 57% and 61%.…”

Rates of local procedural-related structural injury following clipping or coiling of anterior communicating artery aneurysms

“…Clipping was a strong predictor of treatment-related injury on multivariate analysis. The infarct rate for coiling was in line with a recent systematic review of the literature 19. The majority of the surgical lesions were probably ischemic in etiology; most were on the side of the surgical approach.…”