Safe time thresholds for temporary artery occlusion and surgical approach side strategy in ACOM aneurysm surgery

This study evaluates the safety of Temporary Artery Occlusion (TAO) in anterior communicating artery (ACOM) aneurysm surgeries, comparing right-sided and vascular dominance-based approaches, and assessing continuous versus intermittent TAO.

A retrospective analysis of ACOM aneurysm surgeries from 2010 to 2020 was conducted, excluding cases with incomplete data, non-ACOM aneurysms, or endovascular treatments. Outcomes included TAO technique, TAO-related ischemia, intraoperative rupture, and post-surgery neurological status via modified Rankin Score (mRS). Surgical approaches and TAO modalities were examined through regression analyses.

Of 162 patients, 117 (72.2%) underwent TAO, with a safe maximum duration of 12.5 min and a cumulative safe time range of 11-20 min. Ischemic changes following ipsilateral and contralateral A1 TAO were observed in 11.1% and 13.6% of cases, respectively, without significant differences due to surgical lateralization or A1 dominance. Surgical approach did not significantly impact ischemia or intraoperative rupture rates. Postoperative ischemia occurred in 24.1% of patients, increasing to 30.3% in subarachnoid hemorrhage (SAH) cases. Prophylactic TAO markedly decreased intraoperative rupture risk, especially in SAH patients.

The study establishes TAO's safety and efficacy in ACOM aneurysm surgeries, identifying a maximum safe TAO duration and highlighting ischemic risks. Prophylactic unilateral TAO substantially reduces intraoperative rupture risk regardless of A1 dominance or chosen side. Surgical approach and arterial dominance did not significantly influence outcomes, emphasizing the need for judicious TAO application and contributing to refined surgical practices.