Background Stent-assisted coil (SAC) embolization is an alternative treatment option for anterior communicating artery (AcoA) aneurysms.

Objective This study was undertaken to assess the safety and effectiveness of SAC embolization in treating AcoA aneurysms and to determine risk factors for related procedural complications or recanalization.

Methods Between August 2008 and December 2016, a total of 184 patients with AcoA aneurysms were subjected to SAC embolization. Cumulative medical record and radiologic data were analyzed, using binary logistic regression to identify factors predisposing to procedural complications or recanalization.

Results Contralateral A1 segment hypoplasia was observed in 59 patients (32.1%). Three types of stents (LVIS, Enterprise, and Neuroform) were variably placed by one of two routes: 1) ipsilateral A1 to ipsilateral A2 (75.5%) or 2) ipsilateral A1 to contralateral A2 (24.5%). Procedural complications occurred in 17 patients (thromboembolism, 12; procedural leakage, 3; both, 2), showing a significant relation to subarachnoid hemorrhage at presentation (OR=57.750; p<0.01). Occlusion was documented immediately postembolization in 130 aneurysms (70.6%), and in 23 (13.1%) of 175 AcoA aneurysms followed by angiography (median, 25.9±18.5 months), recanalization developed (minor, 15; major, 8). Stent configuration (ipsilateral A1 to contralateral A2, p=0.024), maximum aneurysm size (>7 mm, p<0.01) and A1 segment hypoplasia (p=0.039) were identified as risk factors for recanalization.

Conclusion SAC embolization is a safe and effective method of treating unruptured AcoA aneurysms, regardless of anatomic or clinical features. However, in the event of rupture, procedural complications are likely. Stent configuration, aneurysm size, and A1 segment hypoplasia were identified as significant risk factors for recanalization.

Disclosures Y. Cho: None. H. Kang: None. M. Han: None.