Preliminary study on optimizing head position for endovascular treatment of anterior communicating artery aneurysms

To evaluate the effects of optimized head positioning on procedural efficiency, device utilization, safety, and short-term postoperative activities of daily living in patients undergoing endovascular treatment for anterior communicating artery aneurysms (ACoAA), compared with conventional head positioning, and thereby assess its clinical value.

In this single-center randomized controlled study, 86 patients with ACoAAs scheduled for endovascular treatment at Guangyuan Central Hospital, Affiliated to North Sichuan Medical College, between September 2022 and September 2025 were randomly assigned to a conventional-position group or an optimized-position group. One patient in the conventional group did not undergo the procedure; therefore, 85 patients were included in the final analysis (conventional group, n = 42; optimized group, n = 43). Outcomes included total procedure time, stent-delivery catheter placement time, embolization catheter placement time, coil embolization time, number of coils used, stent use, perioperative complications, and short-term neurological and functional outcomes.

The final analysis included 85 patients. The baseline data of the two groups were comparable. Compared with the conventional group, the optimized group had shorter total procedure times for both stent-assisted coil embolization and standalone coil embolization, shorter catheter-placement and coil-embolization times, and a lower stent-use rate (44.2% vs. 66.7%, p = 0.037). No statistically significant between-group differences were observed in the number of coils used, the perioperative complication rate, postoperative modified Rankin Scale (mRS) scores, or changes in mRS. Several other short-term neurological and functional measures favored the optimized group.

Optimized head positioning was associated with shorter procedure times and lower stent use, without an evident increase in perioperative complications. Several short-term neurological and functional measures also favored the optimized position. This strategy is simple and readily implementable, supporting its potential for broader clinical application.