Safety and efficacy of flow diverters for treatment of unruptured anterior communicating artery aneurysms: Retrospective multicenter study

Victor H. Benalia, Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA.
Gustavo M. Cortez, Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA.Follow
Charbel Mounayer, Interventional Neuroradiology Department, University Hospital Centre of Limoges, Limoges, France.
Isil Saatci, Interventional Neuroradiology Department, Koru Health Group, Ankara, Turkey.
H Saruhan Cekirge, Interventional Neuroradiology Department, Koru Health Group, Ankara, Turkey.Follow
Naci Kocer, Department of Radiology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Fatih, Istanbul, Turkey.
Civan Islak, Department of Radiology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Fatih, Istanbul, Turkey.
Guilherme Dabus, Interventional Neuroradiology and Neuroendovascular Surgery, Miami Neuroscience Institute and Miami Cardiac and Vascular Institute-Baptist Hospital, Miami, Florida, USA.Follow
Waleed Brinjikji, Department of Neurosurgery and Neuroradiology, Mayo Clinic, Rochester, Minnesota, USA.Follow
Feyyaz Baltacioglu, Department of Radiology, Division of Interventional Radiology/Neuroradiology, VKV Amerikan Hastanesi, Istanbul, Turkey.
Vitor M. Pereira, Department of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada.
Hidehisa Nishi, Department of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada.
Adnan H. Siddiqui, Departments of Neurosurgery and Radiology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.
Andre Monteiro, Departments of Neurosurgery and Radiology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.
Demetrius K. Lopes, Advocate Aurora HealthFollow
Amin Aghaebrahim, Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA.
Eric Sauvageau, Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA.
Ricardo A. Hanel, Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA ricardo.hanel@bmcjax.com.

Abstract

Background: The anterior communicating artery (AComm) region is the most common site of intracranial aneurysms, with increased rupture risk compared with other locations. Overall, flow diverters present as a safe and efficacious treatment for intracranial aneurysms, but there is paucity of data for their use in the treatment of unruptured AComm aneurysms. We present the largest multicentric analysis evaluating the outcomes of flow diverters in AComm aneurysm treatment.

Methods: Databases from 10 centers were retrospectively reviewed for unruptured AComm aneurysms treated with flow diverters. Demographics, clinical presentation, radiographic characteristics, procedural complications, and outcomes were assessed.

Results: A total of 144 patients harboring 147 AComm aneurysms were treated between January 2012 and December 2021. Seventy-four were women (51.4%) and median age was 60 (IQR 50-67) years. All were unruptured AComm aneurysms. Half of the cohort had similar anterior cerebral artery sizes (51.4%). The most common morphology was saccular (94.6%), with a branch involvement in 32.7% of cases. Median vessel diameter was 2.4 mm, and the Pipeline Flex was the most prevalent device (32.7%). Median follow-up time was 17 months, with complete occlusion in 86.4% at the last follow-up. Functional independence (modified Rankin Scale score 0-2) was reported in 95.1%. Intraprocedural complications occurred in 5.6%, and postoperative complications were noted in 9.7% of cases. Combined major complication and mortality rate was 2.1%.

Conclusions: Our study suggests that flow diverters are a useful treatment for AComm aneurysms. Mid-term results indicated favorable aneurysm occlusion with a good safety profile. Additional prospective studies with longer follow-up periods and independent adjudication are warranted to better assess these results.

Document Type

Article

PubMed ID

37845019

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