Combined Outcomes of Endovascular or Surgical Treatment of Unruptured Anterior Communicating Artery Aneurysms: Is a More Aggressive Management Strategy Warranted?

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Combined Outcomes of Endovascular or Surgical Treatment of Unruptured Anterior Communicating Artery Aneurysms: Is a More Aggressive Management Strategy Warranted?

World Neurosurg. 2018 Apr 16;:

Authors: Schmalz PGR, Enriquez-Marulanda A, Alturki A, Stapleton CJ, Thomas AJ, Ogilvy CS

Abstract
BACKGROUND: Updated natural history studies suggest anterior communicating artery aneurysms have a higher risk of rupture than formerly appreciated. As endovascular and open techniques advance, morbidity may fall to levels which suggest intervention even for small aneurysms.
OBJECTIVE: Assess treatment risk for smaller, unruptured anterior communicating artery aneurysms.
METHODS: A cross-sectional study of 149 patients with unruptured anterior communicating aneurysms treated over a six-year period was performed. Treatment was based on estimate of highest efficacy/lowest risk for each patient. Outcomes were recorded at three months and one year from treatment. The primary outcome measure was a modified Rankin scale (mRS) of >2 at one year, or persistent cognitive impairment confirmed by a neurologist.
RESULTS: Age averaged 61 years, range 34-84 years. Median aneurysm size was 5.5 mm (IQR 4-7 mm). Clipping was performed in 98 patients (65.8%). Poor outcome was observed in 12 patients (8%). Neither aneurysm size nor treatment method predicated poor outcome. Both a history CAD/MI and age were most significantly associated with poor outcome (CAD/MI OR=8.11, 95% CI 2.20-29.86, p=0.002; Age OR=1.09, 95%CI 1.019-1.17, p=0.013). Dichotomized for age >65 years, the odds of poor outcome increased nearly 11-fold (OR=10.93, 95% CI 2.29-52.03, p=0.003) CONCLUSION: Treatment risk for unruptured anterior communicating artery aneurysms for patients under age 65 is low. Comparing risk with natural history studies, these patients can be expected to outperform natural history within five years. Recognizing the risk of smaller anterior communicating artery aneurysms, these findings suggest treatment may be beneficial even for small lesions.

PMID: 29673817 [PubMed - as supplied by publisher]

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