J Korean Neurosurg Soc.  2011 Aug;50(2):81-88. 10.3340/jkns.2011.50.2.81.

Influence of Clinical and Anatomic Features on Treatment Decisions for Anterior Communicating Artery Aneurysms

• Choi JH
• Kang MJ
• Huh JT

• KMID: 1814110
• DOI: http://doi.org/10.3340/jkns.2011.50.2.81

Abstract

OBJECTIVE
The purpose of this study was to analyze the clinical and anatomic features involved in determining treatment modalities for anterior communicating artery (AcoA) aneurysms.
METHODS
The authors retrospectively evaluated 112 AcoA aneurysms with pretreatment clinical features including age, Hunt and Hess grade, medical or neurological comorbidity, and anatomical features including aneurysm size, neck size, dome-to-neck ratio, vessel incorporation, multiple lobulation, and morphologic scoring system. Post-treatment clinical results were classified according to the Glasgow Outcome Scale, and anatomic results in coiled patients were classified according to the modified Raymond scale. Using multivariate logistic regression, the probabilities for decision making between surgical clipping and coil embolization were calculated.
RESULTS
Sixty-seven patients (60%) were treated with surgical clipping and 45 patients (40%) with endovascular coil embolization. The clinical factor significantly associated with treatment decision was age (> or =65 vs. <65 years) and anatomical factors including aneurysm size (small or large vs. medium), dome-to-neck ratio (<2 vs. > or =2), presence of vessel incorporation, multiple lobulation, and morphologic score (> or =2 vs. <2). In multivariate analysis, older patients (age, >65 years) had significantly higher odds of being treated with coil embolization relative to clipping (adjusted OR=3.78; 95% CI, 1.39-10.3; p=0.0093) and higher morphological score patients (> or =2) had a higher tendency toward surgical clipping than endovascular coil embolization (OR=0.23; 95% CI, 0.16-0.93; p=0.0039).
CONCLUSION
The optimal decision for treating AcoA aneurysms cannot be determined by any single clinical or anatomic characteristics. All clinical and morphological features need to be considered, and a collaborative neurovascular team approach to AcoA aneurysms is essential.

Keyword

Anterior communicating artery aneurysm; Clipping; Coiling; Morphology

MeSH Terms

Aneurysm
Arteries
Comorbidity
Decision Making
Glasgow Outcome Scale
Glycosaminoglycans
Humans
Intracranial Aneurysm
Logistic Models
Multivariate Analysis
Neck
Retrospective Studies
Surgical Instruments
Glycosaminoglycans