Introduction/Purpose Approximately 30–37% of all cerebral aneurysms occur in the anterior communicating artery (AComm), making it the most common site for such lesions. These aneurysms constitute 12–15% of all unruptured and 23–40% of all ruptured cerebral aneurysms, and account for approximately 40% of aneurysmal subarachnoid hemorrhage (SAH) in adults.^1,2 AComm aneurysms, when compared to other anterior circulation cerebral aneurysms, are more likely to rupture, as 50% of those that experience rupture do so at less than 7 mm diameter². Series outlining the safety and efficacy of hydrogel coils in aneurysm treatment show favorable angiographic outcomes, reduced thromboembolic complications, reduced recanalization, recurrence, and procedure-related morbidity and mortality when compared to bare platinum coils.^3,4 However, despite the demonstrated success of hydrogel coils in treating cerebral aneurysms at large, no studies in the United States to date have examined outcomes related to the use of these coils versus bare platinum coils in the treatment of aneurysms of the anterior communicating artery, specifically. This study aims to compare these coil types for efficacy in terms of aneurysm obliteration and recurrence, and coil number and packing density.

Materials and methods A retrospective chart review of 36 patients with untreated, ruptured and unruptured, saccular AComm aneurysms who were treated via bare platinum or hydrogel-coated coil embolization during the period of August 2014 to present was conducted. Data extracted from patient charts included aneurysm size, morphology, rupture status, endovascular coil number, type, and size. Additionally, each aneurysm was assigned a Raymond-Roy Occlusion Classification (RROC) grade based on accompanied follow-up imaging at 6–12 months. RStudio was used to conduct all relevant statistical analysis including Welch’s two-sample t-testing, least-squares regression, and non-parametric testing.

Results Hydrogel coil-treated AComm aneurysms, when compared to those treated with bare metal coils, demonstrated an equal rate of aneurysm obliteration with reductions in average number of coils used per aneurysm (β=-0.4150, P=0.027), packing density per aneurysm (t(26.1)=2.09, 95% CI 0.19–22.62, P=0.046), retreatment (P=0.031), and median six-month recurrence (W=183, P=0.043).

Conclusions In the setting of coil embolization of AComm aneurysms, hydrogel-coated endovascular coils exhibit similar rates of aneurysm obliteration when compared to bare platinum coils, but achieve these obliteration rates with lower mean packing densities, fewer coils used, and lower overall recurrence and retreatment. Based on these findings, we conclude hydrogel coils to be more efficacious than their bare metal counterparts in treating AComm aneurysms.

References

1. Cai, Wu, et al. ‘Anterior communicating artery aneurysm morphology and the risk of rupture.’World neurosurgery109 ( 2018): 119–126.

2. Bijlenga, Philippe, et al.‘Risk of rupture of small anterior communicating artery aneurysms is similar to posterior circulation aneurysms.’Stroke44.11 (2013): 3018–3026.

3. Park JH, et al. ‘Embolization of intracranial aneurysms with HydroSoft coils: results of the Korean multicenter study.’ American Journal of Neuroradiology 32.9 (2011): 1756–1761.

4. White, Philip M, et al. ‘Hydrogel-coated coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms (HELPS): a randomised controlled trial.’ The Lancet 377.9778 (2011): 1655–1662.

Disclosures G. Malaty: None. B. Patel: 1; C; MicroVention, Inc.