医学
前交通动脉
外科
闭塞
剪裁(形态学)
栓塞
回顾性队列研究
大脑前动脉
队列
支架
放射科
作者
Ahmad Sweid,Kareem El Naamani,Rawad Abbas,Robert M Starke,Khodr Badih,Rayan El Hajjar,Hassan Saad,Bassel Hammoud,Carrie Andrews,Sage P Rahm,Elias Atallah,Sunidhi Ramesh,Stavropoula Tjoumakaris,M Reid Gooch,Nabeel Herial,David Hasan,Robert H Rosenwasser,Pascal Jabbour
出处
期刊:Neurosurgery
[Oxford University Press]
日期:2022-03-16
卷期号:90 (5): 627-635
标识
DOI:10.1227/neu.0000000000001905
摘要
The anterior communicating artery (AcoA) is the most common location for intracranial aneurysms.To present occlusion outcomes, complication rate, recurrence rate, and predictors of recurrence in a large cohort with AcoA aneurysms treated primarily with endosaccular embolization. We also attempt to present data on the most effective treatment modality for recurrent AcoA aneurysms.This is a retrospective, single-center study, reviewing the outcomes of 463 AcoA aneurysms treated endovascularly between 2003 and 2018.The study cohort consisted of 463 patients. Adequate immediate occlusion was achieved in 418 (90.3%). Independent functional status at discharge was observed in 269 patients (58.0%), and the mortality rate was 6.8% (31). At 6 months, adequate occlusion was achieved in 418 (90.4%). Of all the patients, recurrence was observed in 101 cases (21.8%), and of those, 98 (22.4%) underwent retreatment. The combined frequency of retreatment for the coiling group was 42.4%, which was significantly higher than the 0 incident of retreatment in the clipping group (P < .0001). Among the retreatment cohort, there was a significantly higher subsequent retreatment rate in the endovascular group (0% in the clipping group vs 42.4% in the endovascular group, P < .0001).Coiling with and without stent/balloon assistance is a relatively safe and effective modality for the treatment of AcoA aneurysms; however, in the setting of recurrence, microsurgical reconstruction leads to improved outcomes regarding durable occlusion, thus avoiding the potential for multiple interventions in the future.
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