• World Neurosurg · Jun 2019

    Endovascular coiling versus surgical clipping of very small ruptured anterior communicating artery aneurysms.

    • Bing Zhao, Haixia Xing, Lianghao Fan, Xianxi Tan, Ming Zhong, Yaohua Pan, and Jieqing Wan.
    • Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Neurosurgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
    • World Neurosurg. 2019 Jun 1; 126: e1246-e1250.

    BackgroundEndovascular coiling of anterior communicating artery (ACoA) aneurysms has evolved dramatically. Ruptured ACoA aneurysms are more likely to be smaller. We aimed to investigate the safety and efficacy of endovascular coiling of very small ruptured ACoA aneurysms compared with surgical clipping.MethodsWe conducted a retrospective analysis of consecutive 111 patients with very small ruptured ACoA aneurysms treated with endovascular coiling or surgical clipping in our single center. Very small aneurysms were defined as aneurysm maximal size ≤3.0 mm. Patients were grouped into coiling and clipping groups. Baseline characteristics, postoperative complications, and clinical outcomes were compared between the 2 groups.ResultsForty-six patients (41.1%) underwent successfully coiling, and 65 patients (58.0%) underwent surgical clipping, including 2 patients who failed coiling and crossed over to surgical clipping. The mean size of the ruptured ACoA aneurysms was 2.6 ± 0.5 mm (range, 1.0-3.0 mm). Patients with smaller aneurysms (P = 0.028) or A1 segment complete configuration (P = 0.009) more often underwent surgical clipping, and patients with A1 segment symmetric configuration more often underwent coiling (P = 0.011). There were not statistically significant differences in intraoperative rupture, early rebleeding, cerebral infarction, and seizure in patients treated with clipping and coiling. Clinical outcomes were similar between the 2 groups. There was no retreatment in both groups.ConclusionsPatients with very small ruptured ACoA aneurysms can be safely and effectively treated with endovascular coiling. However, smaller ACoA aneurysms still require surgical clipping. A smaller aneurysm size limits the use of endovascular coiling.Copyright © 2019 Elsevier Inc. All rights reserved.

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