Treatment of anterior communicating artery aneurysms: complementary aspects of microsurgical and endovascular procedures

Abstract

The direction in which the fundus projects was chosen as the morphological criterion between endovascular and surgical methods. The authors propose that microsurgical clip application should be the preferred option in the treatment of ACoA aneurysms with anteriorly directed fundi and that endovascular packing be selected for those lesions with posteriorly directed fundi, depending on morphological criteria.

Influence of Clinical and Anatomic Features on Treatment Decisions for Anterior Communicating Artery Aneurysms

“…The 5 variables used to calculate the scores were excluded from multivariate analysis to reduce bias due to multicollinearity, a statistical phenomenon in which 2 or more predictor variables in 21,23) and emphasized the close correlation between the vessel and the aneurysm' s anatomic architecture and the need for a more meticulous anatomic analysis. Treatment of ACoA aneurysms has some definite characteristics compared to that of other aneurysms.…”

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

“…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.…”

Treatment Strategies for Complex Intracranial Aneurysms: Review of a 10-Year Experience at the University of Cincinnati

“…Unfortunately, in that respect, most recent publications consist of endovascular series, and site-specific series comparing coiling versus clipping for cerebral aneurysms. 2,4,5,7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]27,31,32, While these comparisons between competing techniques are obviously expected to occur, we feel that, as endovascular treatment for aneurysms continues to evolve and find its definite place in the therapeutic armamentarium, its proven benefits are best weighed in a multidisciplinary, complementary approach. We have experienced the benefits of this therapeutic philosophy as the natural evolution of a collaborative approach to these complex lesions from all possible therapeutic approaches to improve our patient outcomes.…”

“…Recently published data suggest that this approach is associated with better outcomes. 2,5,[8][9][10][11]24,[26][27][28][29] Therapeutic Aspects As with any other cerebrovascular lesion prone to rupture or that has ruptured already, the goal of therapy is exclusion of the aneurysm from the cerebral circulation with preservation of the blood flow in the neural tissues supplied by the parent vessel and its branches, without disrupting the adjacent brain parenchyma. To accomplish this goal, all possible approaches should be considered, either as a sole or a combined modality strategy, which may require one or multiple stages.…”