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Birknes, John K. M.D.; Hwang, Sung-Kyun M.D.; Pandey, Aditya S. M.D.; Cockroft, Kevin M.D., MSc.; Dyer, Anne-Marie M.S.; Benitez, Ronald P. M.D.; Veznedaroglu, Erol M.D.; Rosenwasser, Robert H. M.D.

doi: 10.1227/01.neu.0000243282.60673.31
Clinical Studies

OBJECTIVE: The purpose of this study is to analyze anterior communicating artery aneurysm (ACoA) morphology and its relationship to the limitations and feasibility of endovascular coil embolization.

METHODS: One-hundred-twenty-three patients were treated with endovascular coil embolization for ACoA. Aneurysm morphology was classified into six categories according to projection of aneurysm (anterior, posterior/superior or inferior) and neck size (less than 4 mm or greater than/equal to 4 mm). The following categories were used, class A1: anterior projection and neck of aneurysm < 4 mm, class A2: anterior projection and neck of aneurysm ≥ 4 mm, class B1: posterior (superior) projection and neck of aneurysm < 4 mm, class B2: posterior (superior) projection and neck of aneurysm ≥ 4 mm, class C1: inferior projection and neck of aneurysm < 4 mm, and class C2: inferior projection and neck of aneurysm ≥ 4 mm. Endovascular procedures were categorized as either “successful” or “unsuccessful” according to specific criteria. Additionally, patients were followed for recananlization. Clinical follow-up was obtained at discharge and at 6 months, and was classified according to Glasgow Outcome Scale (GOS).

RESULTS: Complete/near complete aneurysm occlusion was observed in 108 patients (88%); partial embolization was performed in 3 patients (2.4%); and embolization was attempted in 12 patients (9.7%). “Successful” embolization for ACoA was performed in 86 patients of 123 patients (70%) or 77.5% (86 of 111 patients) of those patients where embolization was possible. Statistical analysis demonstrated that anterior projecting aneurysms were more likely to be successfully coiled than either inferior or posterior/superior directed ACoA. Additionally, inferiorly projecting ACoA as well as wide neck aneurysms had a significantly higher rate of recanalization.

CONCLUSION: Endovascular coil embolization of ACoA shows good outcome in our study. Despite advanced modern techniques, there are limitations in the endovascular approach to ACoA. Consideration of aneurysm morphology may be used to guide approaches in treatment of ACoA.

Department of Neurosurgery, Thomas Jefferson University School of Medicine, Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania (Birknes, Pandey, Benitez, Veznedaroglu, Rosenwasser)

Department of Neurosurgery, Ewha Womans University School of Medicine, Seoul, Korea (Hwang)

Department of Neurosurgery, Penn State University School of Medicine, Hershey, Pennsylvania (Cockroft)

Department of Health Evaluation Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania (Dyer)

Reprint requests: Erol Veznedaroglu, M.D., Department of Neurosurgery, Thomas Jefferson University Hospital, 909 Walnut Street, 2nd Floor, Philadelphia, PA 19107. E-mail:, TEL: 215-503-7008, FAX: 215-503-2452

Received, June 1, 2006

Accepted, June 30, 2006

Copyright © by the Congress of Neurological Surgeons