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Original research
Endovascular treatment of ruptured anterior communicating aneurysms: a 17-year institutional experience with coil embolization
  1. Joshua S Catapano,
  2. Katherine Karahalios,
  3. Kavelin Rumalla,
  4. Visish M Srinivasan,
  5. Caleb Rutledge,
  6. Jacob F Baranoski,
  7. Tyler S Cole,
  8. Ashutosh P Jadhav,
  9. Andrew F Ducruet,
  10. Felipe C Albuquerque
  1. Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  1. Correspondence to Dr Felipe C Albuquerque, Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA; Felipe.Albuquerque{at}


Background Ruptured anterior communicating artery (ACoA) aneurysms can be challenging to treat via an endovascular procedure. This study analyzed retreatment rates and neurological outcomes associated with ruptured ACoA aneurysms treated via endovascular coiling.

Methods All patients with a ruptured ACoA aneurysm treated with endovascular coiling from 2003 to 2019 were retrospectively analyzed at a single center. Two comparisons were performed: no retreatment versus retreatment and coil embolization versus balloon-assisted coil embolization. Outcomes included retreatment and neurological outcome assessed via modified Rankin Scale (mRS).

Results During the study period, 186 patients with ruptured ACoA aneurysms underwent coil embolization. Treatment included standard coil embolization (68.3%, n=127), balloon-assisted coiling (28.5%, n=53), and stent-assisted embolization (2.7%, n=5). Angiographic outcomes were as follows: class I, 65.1% (n=121); class II, 28.5% (n=53); and class III, 6.5% (n=12). There were no aneurysm reruptures after the index procedure. The mean (SD) mRS score was 2.7 (2.0) at last follow-up (mortality, 19 (10%)). Retreatment occurred in 9.7% (n=18). Patients with retreatment were younger with lower-grade subarachnoid hemorrhage and more favorable functional status at discharge. Patients with aneurysms >7 mm (n=36) were significantly more likely to have recurrence (22.2% vs 6.7%, P=0.005).

Conclusions Endovascular treatment of ruptured ACoA aneurysms is safe and is associated with low mortality and retreatment rates. Younger patients with favorable functional status and larger aneurysm size are more likely to be retreated. Ruptured aneurysms <4 mm, although prevalent in the study (29%), never required retreatment.

  • aneurysm
  • angiography
  • coil

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  • Contributors JSC: manuscript writing and analysis of data; KK: data collection; KR: statistical analysis; VMS: data collection, editing; CR: editing; JFB: editing; TSC: statistical analysis; APJ: final edits; AFD: final edits; FCA: final edits and final approval.

  • 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 AFD and FCA serve on the editorial board of Journal of NeuroInterventional Surgery. The other authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this manuscript.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.