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Published on: August 11, 2015
Management of Anterior Choroidal Artery Aneurysms: A Retrospective Cohort Study
Andrew Falzon1, Shigeta Miyake2, Tze Phei Kee3
1Department of Neuroradiology, Atkinson Morley Regional Neuroscience Centre, St George's University Hospital, Tooting, London SW17 0QT, UK.
Insights
Endovascular treatment for anterior choroidal artery aneurysms shows a lower recurrence rate and higher favorable outcomes compared to surgical clipping. Both methods are viable, but endovascular approaches offer a favorable safety profile for these challenging aneurysms.
Area of Science:
- Neurosurgery
- Interventional Neuroradiology
- Cerebrovascular Disease
Background:
- Anterior choroidal artery (AChoA) aneurysms present significant treatment challenges due to the eloquent vascular territory they supply.
- Limited collateralization in the AChoA territory increases morbidity risk if compromised during treatment.
- Choosing between endovascular and surgical clipping requires careful consideration of clinical outcomes and procedural risks.
Purpose of the Study:
- To compare the clinical outcomes and procedure-related complications of endovascular and clipping treatments for AChoA aneurysms.
- To provide data to aid physicians in decision-making for managing AChoA aneurysms.
Main Methods:
- Retrospective analysis of 32 ruptured and unruptured AChoA aneurysms treated between 2000 and 2023.
- Procedures included conservative management, surgical clipping, and various endovascular techniques (coiling, balloon-assistance, flow diversion).
- Clinical outcomes and complications were assessed, including infarcts, thromboembolic events, recurrence, and functional outcome (mRS).
Main Results:
- Twenty-four endovascular and seven clipping procedures were analyzed.
- Endovascular treatment showed significantly lower AChoA territory infarct rates (4% vs. 29%) and recurrence rates requiring retreatment (12.5% vs. 43%) compared to clipping.
- Favorable clinical outcomes (mRS ≤ 2) were achieved in 78% of endovascular cases versus 67% of clipping cases; no procedure-related mortality was observed in either group.
Conclusions:
- Endovascular treatment of AChoA aneurysms demonstrates a favorable safety profile and better long-term outcomes compared to surgical clipping.
- Both endovascular and clipping approaches are viable treatment options for AChoA aneurysms, each with distinct risk-benefit profiles.
- Findings support prior studies, highlighting the advantages of endovascular techniques in managing these complex cerebrovascular lesions.
Abstract:
Background: Anterior choroidal artery (AChoA) aneurysms pose a challenge for both endovascular and clipping procedures. The eloquent territory supplied by the parent vessel has limited collateralization and its compromise can lead to significant morbidity. This study aims to analyze the clinical outcomes and procedure-related complications of clipping and endovascular treatment of AChoA aneurysms to aid physician decision making. Methods: Thirty-two ruptured and unruptured AChoA aneurysms that underwent catheter angiography at a single neurovascular center between January 2000 and December 2023 were included. Either conservative management, clipping, and/or endovascular treatment were performed. Clinical outcomes and complications were analyzed retrospectively. Results: Twenty-four endovascular treatments and seven clipping procedures were included. Of the total 24 endovascular procedures, 46% were primary coiling, 25% were balloon-assisted coiling, 13% were flow diverting stent, 8% were combined balloon-assisted coiling and flow diverting stent, and 8% were combined balloon-assisted and stent-assisted coiling. There was no procedure-related mortality in both groups. No intra- or post-procedural ruptures/re-ruptures occurred during follow-up in both endovascular and clipping cohorts. AChoA territory infarcts occurred in 4% of the endovascular and 29% of the clipping cohorts. Other thromboembolic complications occurred in 4% of the endovascular cohort. The recurrence rate requiring retreatment was 12.5% for the endovascular and 43% for the clipping cohort. A favorable clinical outcome (mRS ≤ 2) was 78% for the endovascular cohort and 67% for the clipping cohort. Conclusions: Endovascular and clipping outcomes align with prior studies, with endovascular showing a favorable safety profile. Both approaches are viable, though they present distinct risks and advantages.
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