• Sara Zandpazandi, Hidetoshi Matsukawa, Guilherme Porto, Kimberly Kicielinski, Conor Cunningham, Mohammad Mahdi Sowlat, Sameh Samir Elawady, Atakan Orscelik, Steven Lin, and Alejandro Spiotta.
• Department of Neurological Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
• Neurosurgery. 2023 Dec 5.

Background And ObjectivesEndovascular treatment (EVT) of small anterior communicating artery (ACoA) aneurysms accompanies a high risk of intraprocedural rupture (IR) because of anatomic location and aneurysm orientation. In this study, we aimed to investigate the safety and efficacy of EVT for small ACoA aneurysms in a contemporary cohort.MethodsACoA aneurysms treated at the Medical University of South Carolina between April 2012 and March 2022 were retrospectively analyzed. Periprocedural baseline characteristics, aneurysm size, and clinical and radiological outcomes were collected. Aneurysms were dichotomized into <4 and ≥4 mm in maximum size. The IR rate, favorable occlusion rate (Raymond-Roy I and II), and the favorable outcome defined as modified Rankin Scale 0-2 were compared.ResultsA total of 174 patients were identified, of whom 111 (63.8%) were female, and the median age was 57.7 (interquartile range 50.6-69.6) years. 98 (56.3%) aneurysms were ruptured, and 53 (30.5%) were <4 mm. IR was not observed in unruptured ACoA aneurysms, and there was no significant difference in the IR rates between <4 mm and ≥4 mm ruptured aneurysms (6.5% vs 4.5%, P = .65). Favorable occlusion rate and favorable outcome were observed in 94.7% and 78.2% of patients, respectively.ConclusionEVT of small ACoA aneurysms is safe and effective.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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