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Related Concept Videos

Aneurysm III: Interprofessional Care01:26

Aneurysm III: Interprofessional Care

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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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Related Experiment Video

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Small Ruptured Anterior Communicating Artery Aneurysms in the Endovascular Right-of-First-Refusal Era:

Li Ma1, Samer S Hoz1, Prateek Agarwal1

  • 1Department of Neurological Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.

World Neurosurgery
|September 5, 2025
PubMed
Summary

Endovascular treatment of small ruptured anterior communicating artery (ACoA) aneurysms shows good initial results but has a higher retreatment rate. Coiling very small (≤3mm) ACoA aneurysms carries significant risks.

Keywords:
Anterior communicating arteryIntracranial aneurysmSAHSizeTreatment

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Area of Science:

  • Neurosurgery
  • Interventional Neuroradiology
  • Cerebrovascular Disease

Background:

  • Ruptured small anterior communicating artery (ACoA) aneurysms present unique endovascular treatment challenges.
  • Evaluating outcomes in the current endovascular 'right of first refusal' era is crucial.

Purpose of the Study:

  • To compare endovascular treatment and follow-up results for small ruptured ACoA aneurysms versus other locations.
  • To analyze outcomes stratified by aneurysm size (≤3mm and 3-7mm) and treatment modality.

Main Methods:

  • Retrospective analysis of 449 small ruptured aneurysms (≤7mm).
  • Comparison of ACoA aneurysms (n=155) with non-ACoA counterparts.
  • Stratification by endovascular vs. other treatments, and by size.

Main Results:

  • ACoA aneurysms had higher immediate occlusion rates (89% vs. 74%) but increased 2-year retreatment rates (27% vs. 17%).
  • Smallest ACoA aneurysms (≤3mm) showed higher intraprocedural rupture (12.5%) and retreatment risks (OR 3.8).
  • Endovascular treatment was the first-line option in 68% of cases.

Conclusions:

  • Endovascular treatment of small ruptured ACoA aneurysms is effective initially but requires more frequent retreatment.
  • Coiling aneurysms ≤3mm carries substantial risks of complications and recanalization, necessitating careful consideration.