Current treatment options and prognostic factors for ruptured distal anterior cerebral artery aneurysms

Yushiro Take; Tomoya Kamide; Yuichiro Kikkawa; Masaki Ikegami; Akio Teranishi; Takuro Ehara; Aoto Shibata; Kaima Suzuki; Toshiki Ikeda; Satoshi Iihoshi; Shinya Kohyama; Hiroki Kurita

doi:10.25259/SNI_223_2021

Current treatment options and prognostic factors for ruptured distal anterior cerebral artery aneurysms

Surg Neurol Int. 2021 Apr 19:12:171. doi: 10.25259/SNI_223_2021. eCollection 2021.

Authors

Affiliations

¹ Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.
² Department of Neuroendovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.

Abstract

Background: Distal anterior cerebral artery (ACA) aneurysms are rare, representing 1-9% of all intracranial aneurysms. The best treatment strategy for these aneurysms continues to be debated. We clarified the clinical features and treatment outcomes of patients with ruptured distal ACA aneurysms according to the treatment options at our institute.

Methods: Thirty-seven consecutive patients (26 women; mean age, 65.2 years) with ruptured distal ACA aneurysms who underwent surgical clipping or coil embolization between 2012 and 2018 were included in the study. Clinical presentations, radiographic findings, and outcomes were retrospectively reviewed and compared between patients who underwent either surgical clipping or coil embolization. Risk factors associated with poor outcomes (modified Rankin Scale 4-6) were analyzed using multiple regression analysis.

Results: Nineteen patients (51.4%) had World Federation Neurological Surgeons (WFNS) Grade IV-V, 18 (48.7%) had frontal lobe hematomas, and 13 (35.1%) had multiple aneurysms. Surgical clipping and endovascular coiling were performed in 28 (75.7%) and nine (24.3%) patients, respectively. Aneurysms located at the A4-5 portions were mainly treated by surgical clipping (P = 0.04). There were no significant between-group differences in procedure-related morbidity and mortality; however, the complete occlusion rate was higher in the surgical group (P < 0.01). Overall, a favorable neurological outcome at discharge (mRS 0-3) was obtained in 23 patients (62.5%). Multiple regression analysis revealed that WFNS Grade IV-V and frontal lobe hematomas were risk factors for poor outcomes (mRS 4-6).

Conclusion: Acceptable outcomes were obtained in 62.5% of cases, and there were no significant between-group differences in treatment results between clipping and coiling. A poor WFNS grade and intracerebral hematomas were risk factors for a poor prognosis.

Keywords: Coil embolization; Poor prognosis; Ruptured distal anterior cerebral aneurysm; Surgical clipping; Treatment outcome.