Flow Diverter Devices in the Treatment of Anterior Communicating Artery Region Aneurysms: Would the Regional Anatomy and the Aneurysm Location Affect the Outcomes?

Mariangela Piano; Pietro Trombatore; Emilio Lozupone; Guglielmo Pero; Amedeo Cervo; Antonio Macera; Luca Quilici; Simone Peschillo; Luca Valvassori; Edoardo Boccardi

doi:10.3390/brainsci12111524

Flow Diverter Devices in the Treatment of Anterior Communicating Artery Region Aneurysms: Would the Regional Anatomy and the Aneurysm Location Affect the Outcomes?

Brain Sci. 2022 Nov 10;12(11):1524. doi: 10.3390/brainsci12111524.

Authors

Affiliations

¹ Department of Neuroradiology, Niguarda Hospital, 20162 Milano, Italy.
² Department of Neuroradiology, Ospedale San Gerardo, 20900 Monza, Italy.
³ Department of Neuroradiology, Vito Fazzi Hospital, 73100 Lecce, Italy.
⁴ Department of Neuroradiology, ASST Ospedale Papa Giovanni XXIII, 24127 Bergamo, Italy.
⁵ Department of Neurosurgey, UniCamillus-Saint Camillus International University of Health Sciences, 00131 Rome, Italy.
⁶ Endovascular Neurosurgery, Pia Fondazione Cardinale Giovanni Panico Hospital, 73039 Lecce, Italy.
⁷ Department of Neuroradiology, ASST Santi Paolo e Carlo, 20142 Milano, Italy.

Abstract

Background: In this study, the authors evaluated the efficacy and the safety of flow diverter devices (FDD) in anterior communicating artery (ACoA) region aneurysms, focusing on anatomical factors that could affect the outcome, such as the location of the aneurysm along the ACoA (centered on ACoA or decentered on the A1-A2 junction) and the anatomy of the ACoA region.

Methods: Clinical, procedural and follow-up data were analyzed. Aneurysms were classified according to the location along the ACoA (centered or decentered on the A1-A2 junction) and on the basis of the anatomical configuration of the ACoA region. Safety was assessed by recording intraprocedural, periprocedural and delayed complications to determine the morbidity and mortality rates. The functional outcome was evaluated with the modified Rankin scale (mRS) prior to and after the endovascular procedure. To assess the efficacy, midterm and long-term clinical, angiographic and cross-sectional imaging follow-ups were recorded. Subgroup analysis according to the different ACoA regional anatomical configurations and the ACoA aneurysm locations were performed.

Results: 33 patients (17 males; 16 females) with ACoA region aneurysms were treated with FDDs. 27 aneurysms were located at the A1-A2 junction (82%) while the remaining six aneurysms were centered on the ACoA. No mortality was recorded. The overall morbidity rate was 6% (2/33 procedures). Major complications occurred in 33% (2/6) of ACoA aneurysms and in the 0% of A1-A2 junction aneurysms. Mid-term and long-term neuroimaging follow-ups showed the occlusion of the aneurysm in 28/33 cases (85%). Complete occlusion rates were 93% in the A1-A2 junction aneurysms and 50% in ACoA aneurysms.

Conclusions: The FDD is a safe and effective tool that can be used in the treatment of selected cases of ACoA region aneurysms. The location of the aneurysm along the ACoA and the regional anatomy of the ACoA complex could affect the efficacy and safety.

Keywords: anterior communicating artery; brain aneurysm; endovascular treatment; flow diverter.

Grants and funding

This research received no external funding.