Stent assisted embolization of 64 anterior communicating artery aneurysms

Anterior communicating artery (ACoA) aneurysms comprised over half of the ruptured aneurysms in the International Subarachnoid Trial. Endovascular treatment of ACoA aneurysms has provided good results, but until the introduction of intracranial stents, many ACoA aneurysms could not be treated without craniotomy. The current study analyzes the results of ACoA aneurysm treatment using stent assisted embolization.

64 patients with ACoA aneurysms underwent stent assisted aneurysm repair. Four were treated in the acute rupture phase and a fifth ruptured aneurysm was stented in a second procedure after initial coiling. Five aneurysms were 10 mm or more in greatest diameter. Follow-up angiography was performed 6 months after treatment; then, patients were followed with annual MR angiography. Technical, clinical, and long term radiographic results were analyzed.

Stents were successfully deployed in each case. One patient was eventually treated with a three stent construct and died of perioperative hemorrhage. One major stroke occurred during a separate procedure when a patient was taken off antiplatelet medications. These cases were the only aneurysm related morbidity (1.6%) and mortality (1.6%) events during the entire follow-up period. After stent assisted embolization, 32 (50.0%) ACoA aneurysms were completely occluded, 15 (23.4%) had residual neck, and 17 (26.6%) had residual filling. At first radiographic follow-up, 39 of 55 (70.9%) showed complete occlusion. Three (5.5%) total aneurysms required retreatment.

Stent assisted aneurysm treatment was a safe and effective option in this series of ACoA aneurysms with maximum diameter less than 15 mm. ACoA aneurysms may be more likely to recur regardless of treatment option, but stent assisted embolization may be durable after stable initial radiographic follow-up.