Clinical and morphological risk factors for the recurrence of anterior communicating artery aneurysms after clipping or coiling



The aim of this study was to evaluate clinical and morphological factors associated with recurrence in anterior communicating artery (AcomA) aneurysms after clipping or coiling.


We retrospectively reviewed the clinical and radiologic features of consecutive 214 patients with AcomA aneurysms treated between January 2012 and December 2016 in a single tertiary institute. Univariate and multivariate analyses were performed to identify the relationship between clinical and morphological variables and recurrence.


Of 214 patients, 166 were unruptured aneurysms and 109 were treated with coiling. Overall recurrence rate was 13% (28 out of 214 aneurysms) during mean 36.9 ± 18.4-month follow-up. Multivariate logistic regression analysis showed that size greater than 10 mm (OR = 5.651; 95% CI, 1.317–24.242; p = 0.020), smoking (OR = 3.474; 95% CI, 1.342–8.996; p = 0.010), coiling (OR = 2.98; 95% CI, 1.005–8.832; p = 0.049), and anterior direction of aneurysm (OR = 3.77; 95% CI, 1.12–12.66; p = 0.032) were significantly associated with recurrence of AcomA aneurysms after treatment.


The results of this study demonstrated that coiling, large aneurysm, anterior direction, and smoking history may be independent risk factors for the recurrence of AcomA aneurysms. Therefore, careful follow-up should be needed especially in large AcomA aneurysms with anterior direction after coiling.

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  1. 1.

    Brisman JL, Song JK, Newell DW (2006) Cerebral aneurysms. N Engl J Med 355:928–939.

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Le Roux PD, Elliott JP, Downey L, Newell DW, Grady MS, Mayberg MR, Eskridge JM, Winn HR (1995) Improved outcome after rupture of anterior circulation aneurysms: a retrospective 10-year review of 224 good-grade patients. J Neurosurg 83:394–402.

    Article  PubMed  Google Scholar 

  3. 3.

    Molyneux AJ, Kerr RSC, Birks J, Ramzi N, Yarnold J, Sneade M, Rischmiller J (2009) Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up. The Lancet Neurology 8:427–433.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Grunwald IQ, Papanagiotou P, Struffert T, Politi M, Krick C, Gul G, Reith W (2007) Recanalization after endovascular treatment of intracerebral aneurysms. Neuroradiology 49:41–47.

    Article  PubMed  Google Scholar 

  5. 5.

    Piotin M, Spelle L, Mounayer C, Salles-Rezende MT, Giansante-Abud D, Vanzin-Santos R, Moret J (2007) Intracranial aneurysms: treatment with bare platinum coils--aneurysm packing, complex coils, and angiographic recurrence. Radiology 243:500–508.

    Article  PubMed  Google Scholar 

  6. 6.

    Li C, Wang S, Chen J, Yu H, Zhang Y, Jiang F, Mu S, Li H, Yang X (2012) Influence of hemodynamics on recanalization of totally occluded intracranial aneurysms: a patient-specific computational fluid dynamic simulation study. J Neurosurg 117:276–283.

    Article  PubMed  Google Scholar 

  7. 7.

    Liu J, Jing L, Wang C, Paliwal N, Wang S, Zhang Y, Xiang J, Siddiqui AH, Meng H, Yang X (2016) Effect of hemodynamics on outcome of subtotally occluded paraclinoid aneurysms after stent-assisted coil embolization. J Neurointerv Surg 8:1140–1147.

    Article  PubMed  Google Scholar 

  8. 8.

    Luo B, Yang X, Wang S, Li H, Chen J, Yu H, Zhang Y, Zhang Y, Mu S, Liu Z, Ding G (2011) High shear stress and flow velocity in partially occluded aneurysms prone to recanalization. Stroke 42:745–753.

    Article  PubMed  Google Scholar 

  9. 9.

    Birknes JK, Hwang SK, Pandey AS, Cockroft K, Dyer AM, Benitez RP, Veznedaroglu E, Rosenwasser RH (2006) Feasibility and limitations of endovascular coil embolization of anterior communicating artery aneurysms: morphological considerations. Neurosurgery 59:43–52; discussion 43-52.

    Article  PubMed  Google Scholar 

  10. 10.

    Blackburn SL, Abdelazim AM, Cutler AB, Brookins KT, Fargen KM, Hoh BL, Kadkhodayan Y (2014) Endovascular and surgical treatment of unruptured MCA aneurysms: meta-analysis and review of the literature. Stroke Res Treat 2014:348147.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Fotakopoulos G, Tsianaka E, Fountas K, Makris D, Spyrou M, Hernesniemi J (2017) Clipping versus coiling in anterior circulation ruptured intracranial aneurysms: a meta-analysis. World Neurosurg 104:482–488.

    Article  PubMed  Google Scholar 

  12. 12.

    Hwang JS, Hyun MK, Lee HJ, Choi JE, Kim JH, Lee NR, Kwon JW, Lee E (2012) Endovascular coiling versus neurosurgical clipping in patients with unruptured intracranial aneurysm: a systematic review. BMC Neurol 12:99.

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Ruan C, Long H, Sun H, He M, Yang K, Zhang H, Mao B (2015) Endovascular coiling vs. surgical clipping for unruptured intracranial aneurysm: a meta-analysis. Br J Neurosurg 29:485–492.

    Article  PubMed  Google Scholar 

  14. 14.

    Smith TR, Cote DJ, Dasenbrock HH, Hamade YJ, Zammar SG, El Tecle NE, Batjer HH, Bendok BR (2015) Comparison of the efficacy and safety of endovascular coiling versus microsurgical clipping for unruptured middle cerebral artery aneurysms: a systematic review and meta-analysis. World Neurosurg 84:942–953.

    Article  PubMed  Google Scholar 

  15. 15.

    Shao X, Wang H, Wang Y, Xu T, Huang Y, Wang J, Chen W, Yang Y, Zhao B (2016) The effect of anterior projection of aneurysm dome on the rupture of anterior communicating artery aneurysms compared with posterior projection. Clin Neurol Neurosurg 143:99–103.

    Article  PubMed  Google Scholar 

  16. 16.

    Matsukawa H, Uemura A, Fujii M, Kamo M, Takahashi O, Sumiyoshi S (2013) Morphological and clinical risk factors for the rupture of anterior communicating artery aneurysms. J Neurosurg 118:978–983.

    Article  PubMed  Google Scholar 

  17. 17.

    Malek AM, Alper SL, Izumo S (1999) Hemodynamic shear stress and its role in atherosclerosis. Jama 282:2035–2042.

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Tarulli E, Fox AJ (2010) Potent risk factor for aneurysm formation: termination aneurysms of the anterior communicating artery and detection of A1 vessel asymmetry by flow dilution. AJNR Am J Neuroradiol 31:1186–1191.

    Article  PubMed  Google Scholar 

  19. 19.

    Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, Lamoureux J, Chagnon M, Roy D (2003)Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34:1398–1403.

    Article  PubMed  Google Scholar 

  20. 20.

    Campi A, Ramzi N, Molyneux AJ, Summers PE, Kerr RS, Sneade M, Yarnold JA, Rischmiller J, Byrne JV (2007) Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). Stroke 38:1538–1544.

    Article  PubMed  Google Scholar 

  21. 21.

    Huang DZ, Jiang B, He W, Wang YH, Wang ZG (2017) Risk factors for the recurrence of an intracranial saccular aneurysm following endovascular treatment. Oncotarget 8:33676–33682.

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Park YK, Bae HJ, Cho DY, Choi JH, Kim BS, Shin YS (2019) Risk factors for recurrence and retreatment after endovascular treatment of intracranial saccular aneurysm larger than 8 mm. Acta Neurochir 161:939–946.

    Article  PubMed  Google Scholar 

  23. 23.

    Sluzewski M, Brilstra EH, van Rooij WJ, Wijnalda D, Tulleken CA, Rinkel GJ (2001) Bilateral vertebral artery balloon occlusion for giant vertebrobasilar aneurysms. Neuroradiology 43:336–341.

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Futchko J, Starr J, Lau D, Leach MR, Roark C, Pandey AS, Thompson BG (2018) Influence of smoking on aneurysm recurrence after endovascular treatment of cerebrovascular aneurysms. J Neurosurg 128:992–998.

    Article  PubMed  Google Scholar 

  25. 25.

    Brinjikji W, Lingineni RK, Gu CN, Lanzino G, Cloft HJ, Ulsh L, Koeller K, Kallmes DF (2015) Smoking is not associated with recurrence and retreatment of intracranial aneurysms after endovascular coiling. J Neurosurg 122:95–100.

    Article  PubMed  Google Scholar 

  26. 26.

    McDougall CG, Spetzler RF, Zabramski JM, Partovi S, Hills NK, Nakaji P, Albuquerque FC (2012) The Barrow ruptured aneurysm trial. J Neurosurg 116:135–144.

    Article  PubMed  Google Scholar 

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Corresponding author

Correspondence to Jai Ho Choi.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was executed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the institutional review board at the author’s institute (KC19RASI0866).

Informed consent

The requirement for written informed consent was waived by the ethics committee due to the study’s retrospective design.

Additional information


Anterior communicating aneurysms are commonly encountered in clinical practice. For the most part, they can be treated effectively with intelligent use of microsurgery and endovascular therapy as complementary therapeutic options. In this article, the authors analyze morphological and clinical factors associated with ACom aneurysm recurrence after treatment. As expected, the recurrence rate after surgery is very low and, especially anteriorly pointing Acom aneurysms, have higher tendency to recur after endovascular treatment. However, endovascular treatment continues to evolve. Until a few years ago I continued to offer surgery for broad based Acom aneurysms. In the past 3 years, with newer stents, increasing use of flow diverters for Acom aneurysms and the WEB device, the number of Acom aneurysms for which I offer surgical treatment has decreased dramatically. Based on early follow-up of Acom aneurysms treated with these newer endovascular techniques, it is my impression that recurrence rates, even for inferiorly pointing Acom aneurysms, are dropping.

Giuseppe Lanzino.


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This article is part of the Topical Collection on Vascular Neurosurgery - Aneurysm

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Ki, H.J., Lee, K.S., Kim, B.S. et al. Clinical and morphological risk factors for the recurrence of anterior communicating artery aneurysms after clipping or coiling. Acta Neurochir (2020).

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  • Anterior communicating artery aneurysm
  • Aneurysm direction
  • Recurrence
  • Risk factor