Document Detail

Endovascular Therapy of Very Small Aneurysms of the Anterior communicating Artery: Five-fold Increased Incidence of Rupture.
MedLine Citation:
PMID:  21164380     Owner:  NLM     Status:  Publisher    
BACKGROUND:: Intraprocedural rupture is a dangerous complication of endovascular treatment. Small ruptured anterior communicating artery (AcoA) aneurysms and microaneurysms present a challenge for both surgical and endovascular therapies to achieve obliteration. An understanding of the complication rates of treating ruptured AcoA microaneurysms may help guide therapeutic options. OBJECTIVE:: To report the largest cohort of ACoA microaneurysms treated with endovascular therapy over the course of the last 10 years. METHODS:: We performed a retrospective review of 347 AcoA aneurysms treated in 347 patients at Cleveland Clinic and Emory University over a ten-year period. Patient demographics, aneurysmal rupture, size, use of balloon remodeling, patient outcomes, intraprocedural rupture, and rerupture were reviewed. RESULTS:: Rupture rates were examined by size for all patients and subgroups as well as dichotomized to evaluate for size ranges associated with increased rupture rates. The highest risk of rupture was noted in aneurysms less than 4 mm. Of 347 aneurysms, 74 (21%) were less than 4 mm. The intraprocedural rupture rate was 5% (18/347) for AcoA aneurysms of any size. There was an intraprocedural rupture rate of 2.9% (8/273) among AcoA aneurysms greater than 4 mm compared to 13.5% (10/74) in less than 4 mm aneurysms. Procedural rupture was a statistically significant predictor of modified Rankin score (mRs) after adjusting for Hunt and Hess grades (HH). CONCLUSION:: AcoA aneurysms less than 4 mm have a five-fold higher incidence of intraprocedural rerupture during coil embolization. Outcome is negatively affected by intraprocedural rerupture after adjusting for HH grade.
Albert J Schuette; Ferdinand K Hui; Alejandro M Spiotta; Nancy A Obuchowski; Rishi Gupta; Shaye I Moskowitz; Frank C Tong; Jacques E Dion; Charles M Cawley
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2010-12-15
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-12-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1Emory University Department of Neurosurgery; 2Cerebrovascular Center, Cleveland Clinic Foundation.
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