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Hemorrhagic Stroke
Original research
Comparative analysis of coil embolization in posterior and anterior communicating artery aneurysms
  1. Hyun Ho Choi1,
  2. Young Dae Cho2,
  3. Dong Hyun Yoo2,
  4. Su Hwan Lee2,
  5. Eung Koo Yeon2,
  6. Hyun-Seung Kang3,
  7. Won-Sang Cho3,
  8. Jeong Eun Kim3,
  9. Moon Hee Han4
  1. 1 Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea, Seoul, The Republic of Korea
  2. 2 Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, The Republic of Korea
  3. 3 Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, The Republic of Korea
  4. 4 Department of Radiology, Korea Veterans Hospital Medical Center, Seoul, The Republic of Korea
  1. Correspondence to Dr Young Dae Cho, Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, The Republic of Korea; aronnn{at}naver.com

Abstract

Background Recanalization rates after coil embolization are known to be higher in cerebral aneurysms of the posterior (vs anterior) circulation. Although often grouped with anterior lesions, aneurysms of the posterior communicating artery (PcoA) may nevertheless behave differently.

Objective We performed a comparative analysis to explore differences in recanalization rates of PcoA and anterior communicating artery (AcoA) aneurysms, both integral to the circle of Willis.

Methods Between October 2012 and July 2017, 699 AcoA (n=427) and PcoA (n=272) aneurysms were treated by endovascular coil embolization, monitoring 667 (95.4%) via radiologic imaging for ≥ 6 months. Cumulative recordings of medical and imaging data were retrospectively reviewed, conducting propensity score matching and binary logistic regression analysis.

Results In the 667 aneurysms followed longer term, recanalization occurred in 111 (16.6%; minor 72; major 39) and was significantly more frequent in PcoA (25.5%) than in AcoA (11.0%; P<0.01) aneurysms during similar follow-up periods. After 1:1 propensity score matching, an even greater proclivity for recanalization was evident at PcoA sites (PcoA 23.0%; AcoA 12.2%; P<0.01). Although A1 segment dominance was linked to recanalization in AcoA aneurysms (18.2% vs 7.6%; P=0.01), the PcoA counterpart had no bearing on recanalization (27.7% vs 24.1%; P=0.51).

Conclusions Despite a clear preponderance of AcoA aneurysms, recanalization of PcoA aneurysms proved significantly greater, attesting to posterior circulation behavior.

  • aneurysm
  • coil
  • hemorrhage

https://doi.org/10.1136/neurintsurg-2018-014490

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    Footnotes

    • Contributors HHC conceived and conducted the review of this series, analyzed the data, drafted and revised the manuscript, and approved the final version. DHY, SHL, EKY, H-SK, W-SC, JEK, and MHH performed the operations, assisted in conducting the review of the series, 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 The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The study was approved by the local institutional review board.

    • Provenance and peer review Not commissioned; externally peer reviewed.