Feasibility and Limitations of Endovascular Coil Embolization of Anterior Communicating Artery Aneurysms: Morphological Considerations

Birknes, John K.; Hwang, Sung Kyun; Pandey, Aditya S.; Cockroft, Kevin M.; Dyer, Anne Marie; Benitez, Ronald P.; Veznedaroglu, Erol; Rosenwasser, Robert H.

doi:10.1227/01.neu.0000219220.25721.b9

Cited by 58 publications

(45 citation statements)

References 24 publications

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“…Nevertheless, some experienced authors reported their successful endovascular treatments of AcomA aneurysms with minimal complication rates. [4][5][6] The effect of endovascular embolization is closely related to the aneurysm neck size. Aneurysms with a small neck were more likely to be successfully coiled.…”

Section: Discussionmentioning

confidence: 99%

“…3 Although several articles have reported successful embolization of AcomA aneurysms with minimal complications, endovascular treatment for wide-neck AcomA aneurysms remains technically challenging. [4][5][6] Various adjunctive techniques have been used to facilitate coil embolization of these lesions, including neck remodeling by using balloons or microguidewires, and simultaneous deployment of coils. 7,8 Stent-assisted embolization has also been proposed as an alternative to achieve endovascular reconstruction of complex aneurysms.…”

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confidence: 99%

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Stent-Assisted Embolization of Wide-Neck Anterior Communicating Artery Aneurysms: Review of 21 Consecutive Cases

Huang¹,

Xu²,

Hong³

et al. 2009

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Stent-Assisted Embolization of Wide-Neck Anterior Communicating Artery Aneurysms: Review of 21 Consecutive Cases

Huang¹,

Xu²,

Hong³

et al. 2009

AJNR Am J Neuroradiol

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“…1,[6][7][8][9][10] In the past 2 decades, the inherently less invasive endovascular approach has emerged as a feasible and acceptable treatment option for AcomA aneurysms. [11][12][13][14] Continual advancements in endovascular technique and adjuvant devices have led to an enlarging proportion of patients with AcomA aneurysms who are successfully treated with coil embolization. 10,11,15,16 A limited number of case series have detailed the clinical outcomes, angiographic results, and procedure-related complications specific for endovascular treatment in this location.…”

mentioning

confidence: 99%

“…10,11,15,16 A limited number of case series have detailed the clinical outcomes, angiographic results, and procedure-related complications specific for endovascular treatment in this location. [10][11][12][13][15][16][17][18][19][20][21][22][23][24] We performed a systematic review of the published literature to better define safety and efficacy profiles for coil embolization of AcomA aneurysms beyond single-center experiences.…”

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confidence: 99%

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

Fang

Brinjikji

Murad

et al. 2013

American Journal of Neuroradiology

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“…2,10 2) very small (< 3 mm) aneurysm; 2,5,10 3) widenecked aneurysms requiring stent-assisted technology; 7,11 and 4) aneurysms with an arterial branch incorporated into the sac, 6,8 as long as the patients had no problems related to comorbidity or hemostasis.…”

Section: Methods Patient Populationmentioning

confidence: 99%

Height of aneurysm neck and estimated extent of brain retraction: powerful predictors of olfactory dysfunction after surgery for unruptured anterior communicating artery aneurysms

Park

Son²,

Goh³

et al. 2016

JNS

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A pterionAl approach and its modifications are commonly used for clipping most anterior circulation aneurysms. In such an approach, the frontal lobe and olfactory nerve are both retracted to some degree to access aneurysms located in the circle of Willis. In particular, in cases of an anterior communicating artery (ACoA) aneurysm, a retractor is placed across the olfactory tract, which is damaged primarily by retractor pressure and strain. Thus, olfactory dysfunction following a pterional approach occurs most frequently in cases of ACoA aneuaBBreViatiONS ACoA = anterior communicating artery; AUC = area under the ROC curve; CTA = CT angiography; DSA = digital subtraction angiography; ROC = receiver operating characteristic; SAH = subarachnoid hemorrhage. OBJectiVe The highest incidence of olfactory dysfunction following a pterional approach and its modifications for an intracranial aneurysm has been reported in cases of anterior communicating artery (ACoA) aneurysms. The radiological characteristics of unruptured ACoA aneurysms affecting the extent of retraction of the frontal lobe and olfactory nerve were investigated as risk factors for postoperative olfactory dysfunction. methOdS A total of 102 patients who underwent a pterional or superciliary keyhole approach to clip an unruptured ACoA aneurysm from 2006 to 2013 were included in this study. Those patients who complained of permanent olfactory dysfunction after their aneurysm surgery, during a postoperative office visit or a telephone interview, were invited to undergo an olfactory test, the Korean version of the Sniffin' Sticks test. In addition, the angiographic characteristics of ACoA aneurysms, including the maximum diameter, the projecting direction of the aneurysm, and the height of the neck of the aneurysm, were all recorded based on digital subtraction angiography and sagittal brain images reconstructed using CT angiography. Furthermore, the extent of the brain retraction was estimated based on the height of the ACoA aneurysm neck. reSultS Eleven patients (10.8%) exhibited objective olfactory dysfunction in the Sniffin' Sticks test, among whom 9 were anosmic and 2 were hyposmic. Univariate and multivariate analyses revealed that the direction of the ACoA aneurysm, ACoA aneurysm neck height, and estimated extent of brain retraction were statistically significant risk factors for postoperative olfactory dysfunction. Based on a receiver operating characteristic (ROC) analysis, an ACoA aneurysm neck height > 9 mm and estimated brain retraction > 12 mm were chosen as the optimal cutoff values for differentiating anosmic/hyposmic from normosmic patients. The values for the area under the ROC curves were 0.939 and 0.961, respectively. cONcluSiONS In cases of unruptured ACoA aneurysm surgery, the height of the aneurysm neck and the estimated extent of brain retraction were both found to be powerful predictors of the occurrence of postoperative olfactory dysfunction.

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Feasibility and Limitations of Endovascular Coil Embolization of Anterior Communicating Artery Aneurysms: Morphological Considerations

Cited by 58 publications

References 24 publications

Stent-Assisted Embolization of Wide-Neck Anterior Communicating Artery Aneurysms: Review of 21 Consecutive Cases

Stent-Assisted Embolization of Wide-Neck Anterior Communicating Artery Aneurysms: Review of 21 Consecutive Cases

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

Height of aneurysm neck and estimated extent of brain retraction: powerful predictors of olfactory dysfunction after surgery for unruptured anterior communicating artery aneurysms

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