Feasibility & Limitations of Endovascular Coil Embolization of Anterior Communicating Artery Aneurysms

Hwang, Sung Kyun; Benitez, Ronald; Veznedaroglu, Erol; Rosenwasser, Robert H

Abstract

OBJECTIVE
The purpose of this study is to analyze aneurysm morphology and define limitations and feasibility in endovascular Gugliemi detachable coil(GDC) embolization for anterior communicating artery (ACoA) aneurysms. METHODS: From January 2000 through October 2003, 123patients were treated with endovascular coil embolization for ACoA aneurysms. There were 75women and 48men, with a mean age of 63years. All ruptured aneurysms were treated within 15days of rupture. Aneurysm morphology was classified according to neck size and projection of aneurysm dome as follows - A: neck of aneurysm <4mm & anterior projection, B: neck of aneurysm (4mm & anterior projection, C: neck of aneurysm <4mm & posterior (superior) projection, D: neck of aneurysm (4mm & posterior (superior) projection, E: neck of aneurysm <4mm & inferior projection, and F: neck of aneurysm (4mm & inferior projection. Endovascular procedures were categorized as either "successful" or "unsuccessful". Clinical follow-up was estimated at discharge and at 6months, post treatment results were classified according to Glasgow Outcome Scale(GOS) RESULTS: Successful embolization for ACoA was performed in 86patients of 123patients (69.9%). Complete or near complete aneurysm occlusion was observed in 102patients (82.9%); a neck remnant was observed in 6patients (4.9%); partial embolization was done in 3patients (2.4%); and embolization was attempted in 12patients (9.8%). Among 55patients with follow-up angiographic results, 18patients (32.7%) were defined as recanalization of the aneurysm sac. Morphological analysis demonstrated that anterior projecting aneurysms and morphological classifications (morphological classifications worsens (A - D), chances of successful coil occlusion significantly decrease) were major factors in successful embolization, and, inferiorly projecting and wide neck (> or =4mm) aneurysms are highly related to recanalization of aneurysms. CONCLUSION: Endovascular coil embolization of ACoA aneurysms shows good outcome in our study. Nevertheless, there is a limitation in the endovascular approach to ACoA, even though advanced modern techniques evolve rapidly. Compensatory surgical approach with the endovascular approach is required for successful treatment of ACoA aneurysms.