Introduction Stent-assisted coil (SAC) embolization is an alternative treatment option for anterior communicating artery (AcoA) aneurysms. 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, 184 patients with AcoA aneurysms were treated with 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 after embolization 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.
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Contributors HHC conceived and conducted the review of this series, analyzed the data, drafted and revised the manuscript, and approved the final version. JJL, H-SK, MHH, W-SC, JEK, SJA, JHM, and DHY assisted in conducting the review of the series, performed the operations, revised the manuscript, and approved the final draft. YDC conceived and conducted the project, performed the operations, analyzed the data, revised the manuscript, and approved the final draft.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Ethics approval Seoul National University Hospital (1802-114-924).
Provenance and peer review Not commissioned; externally peer reviewed.