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

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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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Authors

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.

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Comments

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.

USA

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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). https://doi.org/10.1007/s00701-020-04450-2

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Keywords

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