Recurrence and retreatment of anterior communicating artery aneurysms after endovascular treatment: a retrospective study

Abstract

Background S urgical treatment of anterior communicating artery (Acom) aneurysm is challenging due to anatomic complexity. We aimed to describe our experiences with endovascular treatment (EVT) of Acom aneurysms, and to evaluate the incidence and risk factors of recurrence and retreatment. Methods The study comprised 260 patients who were treated at a single center between January 2010 and December 2018. Patients who had EVT, including stent-assisted coiling of Acom aneurysms, were included. All medical records were retrospectively reviewed. The incidence and risk factors of recurrence and retreatment were evaluated. Univariate and multivariate analysis were conducted. Results Recurrence of Acom aneurysms occurred in 38 (14.6%) patients. Mean follow-up duration was 27 months (range 1–110). Multivariate logistic regression indicated that ruptured aneurysm (odds ratio [OR] 3.55, P = 0.001), dome direction (anterior) (OR 3.86, P = 0.002), maximal diameter (OR 1.19, P = 0.02), and mean age (OR 0.96, P = 0.02) were independent risk factors for aneurysm recurrence. Of 38 cases of recurrence, 10 (3.8%) patients underwent retreatment. Ruptured aneurysm (OR 14.7, P = 0.004), maximal diameter (OR 1.56, P = 0.02), inflow angle (OR 1.04, P = 0.03), and Raymond-Roy classes II and III (OR 6.19, P = 0.03) showed significant relation to retreatment in multivariate logistic regression analysis. Conclusions In our study, recurrence rate of Acom aneurysms after EVT was 14.6%. Rupture, anterior dome direction, maximal diameter, and mean age were significantly associated with recurrence. Retreatment rate of recurrent Acom aneurysms after EVT was 3.8%. Patients with Acom aneurysms with large inflow, rupture, large size, or incomplete occlusion may be at a high risk of retreatment of recurring aneurysm.

Endovascular treatment of ruptured anterior communicating aneurysms: a 17-year institutional experience with coil embolization

“…A study reporting a 9-year experience of ruptured ACoA aneurysms, published in 2017, found a similar retreatment percentage of only 10%; that study also found that 79% of patients had an mRS score of <3 on follow-up 15. Interestingly, in 2020, Jang et al analyzed 77 patients with ruptured ACoA aneurysms treated with coil embolization and found a similar 10% retreatment rate (n=8) 16. The mortality rate found in the present study was only 10% (19/186), which is consistent with earlier endovascular literature (10%–31%) 17–19.…”

“…Park et al found that incomplete occlusion is a significant risk factor for recurrence (odds ratio (OR) 2.72, P=0.02) 23. Similarly, Jang et al reported that class II and III occlusions were significantly associated with retreatment rate (OR 6.19, P=0.03) 16…”

“…Additionally, Gonzalez et al found that large dome size is a positive predictor for recanalization, potentially requiring retreatment 22. Multiple studies implemented both multivariable and univariable analyses and proved that large aneurysm dome size is a statistically significant risk factor for retreatment 16 21 23. Interestingly, BAC embolization of ruptured ACoA aneurysms appeared to possibly decrease the retreatment rate among patients with large aneurysms.…”

Physiologic Flow Diversion Coiling Technique for Wide-Necked Aneurysms with an Asymmetric Bidirectional Flow at the Aneurysm Neck

“…8 The asymmetry in the CoW raises wall shear stress and may play a critical role in the development and recurrence of cerebral aneurysms after treatment. [9][10][11][12] This risk increases with the degree of flow contribution from the 2 adjacent anatomical segments of the CoW. This difference may result from the actual difference in the artery diameters, or it may be due to variation in the blood flow among the carotid and basilar arteries across the ACoA and PCoA.…”

Microsurgical Clipping Anterior Communicating Artery Aneurysm After Endovascular Coiling. Case Report.

“…(2020) сообщили, что частота рецидивирования аневризм передней соединительной артерии после их окклюзии спиралями, в том числе с использованием стент-ассистенции, может достигать 14,6%, а необходимость в повторном вмешательстве -3,8% [5].…”