• Roel Haeren, Ahmad Hafez, Miikka Korja, Rahul Raj, and Mika Niemelä.
• Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands. Electronic address: roel.haeren@mumc.nl.
• World Neurosurg. 2022 Sep 1; 165: e668e679e668-e679.

ObjectiveAnterior communicating artery aneurysms (ACoAAs) are challenging to treat both surgically and endovascularly. In this study, we evaluate the treatment-related morbidity and clinical outcome of microsurgical clipping and endovascular treatment for a consecutive series of unruptured ACoAAs while the treatment paradigm was in transition from surgical to endovascular first.MethodsWe retrospectively reviewed clinical and radiologic data of adult patients who underwent microsurgical clipping or endovascular treatment of an unruptured ACoAA at a high-volume academic neurovascular center (Helsinki University Hospital) during 2012-2019. During this period, a transition from microsurgical clipping to endovascular treatment took place. Regarding outcome, we focused on treatment-related complications, discharge-to-home rates, functional performance (modified Rankin Scale score), and obliteration rates.ResultsOf 128 treated ACoAAs, 81 (64%) were treated surgically and 47 (36%) endovascularly. There was no difference in major complications, intracranial hemorrhagic complications or ischemic complications, discharge-to-home rates, or functional performance between the surgically and endovascularly treated patients. With time, a decrease in major complications was observed in the surgical cases (from 29% to 17%), whereas the major complication rate increased in the endovascularly patients (from 0% to 25%). Cerebral ischemia was the most frequent complication in both groups. The risk for permanent neurologic deficit remained low in both groups (9% for endovascular and 5% for surgery).ConclusionsWe did not find any major differences regarding complications and outcomes after the treatment paradigm shift from clipping to endovascular of unruptured ACoAAs. Prospective studies evaluating durability of treatments are needed to compare overall effectiveness.Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.

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