• Ahmad Sweid, Kareem El Naamani, Rawad Abbas, Robert M Starke, Khodr Badih, Rayan El Hajjar, Hassan Saad, Bassel Hammoud, Carrie Andrews, Sage P Rahm, Elias Atallah, Sunidhi Ramesh, Stavropoula Tjoumakaris, M Reid Gooch, Nabeel Herial, David Hasan, Robert H Rosenwasser, and Pascal Jabbour.
• Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
• Neurosurgery. 2022 May 1; 90 (5): 627635627-635.

BackgroundThe anterior communicating artery (AcoA) is the most common location for intracranial aneurysms.ObjectiveTo present occlusion outcomes, complication rate, recurrence rate, and predictors of recurrence in a large cohort with AcoA aneurysms treated primarily with endosaccular embolization. We also attempt to present data on the most effective treatment modality for recurrent AcoA aneurysms.MethodsThis is a retrospective, single-center study, reviewing the outcomes of 463 AcoA aneurysms treated endovascularly between 2003 and 2018.ResultsThe study cohort consisted of 463 patients. Adequate immediate occlusion was achieved in 418 (90.3%). Independent functional status at discharge was observed in 269 patients (58.0%), and the mortality rate was 6.8% (31). At 6 months, adequate occlusion was achieved in 418 (90.4%). Of all the patients, recurrence was observed in 101 cases (21.8%), and of those, 98 (22.4%) underwent retreatment. The combined frequency of retreatment for the coiling group was 42.4%, which was significantly higher than the 0 incident of retreatment in the clipping group (P < .0001). Among the retreatment cohort, there was a significantly higher subsequent retreatment rate in the endovascular group (0% in the clipping group vs 42.4% in the endovascular group, P < .0001).ConclusionCoiling with and without stent/balloon assistance is a relatively safe and effective modality for the treatment of AcoA aneurysms; however, in the setting of recurrence, microsurgical reconstruction leads to improved outcomes regarding durable occlusion, thus avoiding the potential for multiple interventions in the future.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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