Evaluation of Early Recurrence after Coil Embolization for Ruptured Anterior Communicating Artery Aneurysms

We retrospectively examined the risk factors for early recurrence in patients with ruptured anterior communicating artery (AcomA) aneurysms who underwent coil embolization.

Forty-four patients with ruptured AcomA aneurysms who underwent coil embolization between January 2012 and June 2021 were included. Patient backgrounds, anatomical features, intraoperative anticoagulation, and radiological findings before and after treatment were reviewed retrospectively. Univariate analysis was performed separately for each item investigated in the early recurrence (ER) and non-early recurrence (NER) groups. Additionally, the relationship between changes in embolic status (Raymond-Roy classification [RRC]) from immediately after surgery to 2 weeks later and severity of disease was investigated.

Re-treatment was performed in a total of 8 (18.2%) cases. Two cases were detected and treated in the chronic phase with no re-rupture. In the ER group, 6 (13.6%) cases had RRC class 3 filling without evidence of coil compaction on digital subtraction angiography performed 2 weeks after the initial embolization, and were re-treated. The mean intraoperative activated clotting time (ACT; p = 0.0226; NER median 189.5 s, ER median 149 s), contralateral A1 diameter (p = 0.0264; NER median 0.85 mm, ER median 0.26 mm), and volume embolization rate (VER; p = 0.02, NER median 35.57%, ER median 20.86%) were significantly lower in the ER group. The more severe the Hunt and Hess grade, the worse the embolic condition (RRC) tended to be after 2 weeks (p = 0.0339).

In this study, factors such as low intraoperative ACT, low VER, contralateral A1 hypoplasia, and condition severity may be associated with early recurrence after acute coil embolization for ruptured AcomA aneurysms.