Background Previous studies have suggested that anterior communicating artery (ACoA) microaneurysms (<4 mm) were associated with a higher rate of peri-procedure complications when compared to ACoA aneurysms that were 4 mm or larger. We aimed to evaluate the outcomes of patients with unruptured ACoA aneurysms according to aneurysm size in a large, contemporary registry.

Methods We reviewed the prospective, multicenter SMART registry to identify patients with unruptured ACoA aneurysm who were treated with endovascular embolization using the SMART coils. We aimed to report the angiographic outcome and peri-procedural complications of endovascular embolization of ACoA aneurysm according to the aneurysm size (<4 mm vs. ≥4 mm).

Results Out of 906 patients included in the SMART registry, 146 (16.1%) patients had unruptured ACoA aneurysms (age 60.8 ±11.9 yr and 61.6% were females). Of those ACoA, 43 were <4 mm (micro-aneurysms). Microaneurysms were more likely to be wide-necked (84.6% vs. 54.2%, P 0.016). No difference was found in the rate of peri-procedural device related adverse effects, periprocedural mortality, rate of adequate occlusion immediately and at one-year, length of hospitalization and one-year recanalization rate between both groups (table 1).

Conclusions Endovascular treatment of unruptured ACoA microaneurysms is associated with similar successful embolization and complication rates compared to larger size ACoA aneurysms.

Disclosures E. Almallouhi: None. M. Sattur: None. S. Al kasab: None. M. Anadani: None. A. Spiotta: 2; C; Penumbra, Cerenovus, Minnetronix.