Purpose To evaluate management strategies, efficacy and clinical outcomes of anterior cerebral artery aneurysm endovascular treatment at a low volume community hospital.
Material and Methods Prospective data entry and retrospective review of endovascular anterior cerebral artery aneurysms (ACA) treatment was performed from September 2004 to November 2009. Endovascular treatment of 17 anterior ACA (7 ruptured and 10 unruptured) was performed for 17 consecutive patients (6 males, 11 female; mean age 65.2 years). Procedural adverse events, morbidity, mortality, hospital length of stay and angiographic outcomes were analyzed.
Results Three aneurysms were treated with Neuroform stent placement and two aneurysms were treated with balloon support. Complete occlusion was achieved in 64.7% (11/17) aneurysms. A residual neck was present in 35.2% (6/17). None showed aneurysm filling. Permanent procedure related morbidity and mortality was 0% and 5.2% (1/17), respectively. The single death occurred in a Fisher and Hunt and Hess Grade 4 patient with a procedural aneurysm perforation. Procedural adverse events occurred in 4 (21%) patients. This included 2 (10.5%) aneurysm perforations, 1 (5.8%) thromboembolic event and 1 (5.85%) stretched coil. At a mean 6 months angiographic follow-up, persistent complete occlusion was identified in 58.3% (7/12) of aneurysms. 16.6% (2/12) demonstrated a residual neck and 25% (3/12) aneurysm refilling. Two aneurysms were retreated with subsequent complete occlusion. Mean hospital length of stay was 2 days.
Conclusion Endovascular coil embolization of anterior cerebral artery aneurysms at a low community hospital is feasible with acceptable clinical outcomes.
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