• Michel Roethlisberger, Soheila Aghlmandi, Jonathan Rychen, Alessio Chiappini, Daniel W Zumofen, Schatlo Bawarjan, Martin N Stienen, Christian Fung, Donato D'Alonzo, Nicolai Maldaner, Valentin K Steinsiepe, Marco V Corniola, Johannes Goldberg, Alessandro Cianfoni, Thomas Robert, Rodolfo Maduri, Guillaume Saliou, Daniele Starnoni, Johannes Weber, Martin A Seule, Jan Gralla, David Bervini, Zsolt Kulcsar, Jan-Karl Burkhardt, Oliver Bozinov, Luca Remonda, Serge Marbacher, Karl-Olof Lövblad, Marios Psychogios, Heiner C Bucher, Luigi Mariani, Philippe Bijlenga, Kristine A Blackham, Raphael Guzman, and Swiss SOS group.
• Departments of Neurosurgery and Interventional Neuroradiology, University Hospital Basel, University of Basel, Basel, Switzerland.
• Neurosurgery. 2023 Feb 1; 92 (2): 370381370-381.

BackgroundVery small anterior communicating artery aneurysms (vsACoA) of <5 mm in size are detected in a considerable number of patients with aneurysmal subarachnoid hemorrhage (aSAH). Single-center studies report that vsACoA harbor particular risks when treated.ObjectiveTo assess the clinical and radiological outcome(s) of patients with aSAH diagnosed with vsACoA after aneurysm treatment and at discharge.MethodsInformation on n = 1868 patients was collected in the Swiss Subarachnoid Hemorrhage Outcome Study registry between 2009 and 2014. The presence of a new focal neurological deficit at discharge, functional status (modified Rankin scale), mortality rates, and procedural complications (in-hospital rebleeding and presence of a new stroke on computed tomography) was assessed for vsACoA and compared with the results observed for aneurysms in other locations and with diameters of 5 to 25 mm.ResultsThis study analyzed n = 1258 patients with aSAH, n = 439 of which had a documented ruptured ACoA. ACoA location was found in 38% (n = 144/384) of all very small ruptured aneurysms. A higher in-hospital bleeding rate was found in vsACoA compared with non-ACoA locations (2.8 vs 2.1%), especially when endovascularly treated (2.1% vs 0.5%). In multivariate analysis, aneurysm size of 5 to 25 mm, and not ACoA location, was an independent risk factor for a new focal neurological deficit and a higher modified Rankin scale at discharge. Neither very small aneurysm size nor ACoA location was associated with higher mortality rates at discharge or the occurrence of a peri-interventional stroke.ConclusionVery small ruptured ACoA have a higher in-hospital rebleeding rate but are not associated with worse morbidity or mortality.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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