Treatment results and long-term outcomes of endovascular treatment of 96 unruptured anterior communicating artery aneurysms: A large single-center study

Objective: Data on endovascular treatment of unruptured anterior communicating artery (AcomA) aneurysms remain limited. Therefore, to clarify the outcomes of treatment for unruptured AcomA aneurysms, we retrospectively analyzed a single-center series of 96 unruptured AcomA aneurysms treated endovascularly. Methods: Endovascular treatment of 100 unruptured AcomA aneurysms was performed at our institution between May 2009 and May 2019; of these, 96 consecutive aneurysms (95 patients) were included in this retrospective study. Recanalization and retreatment rates were investigated for 76 aneurysms through follow-up using time-of-flight magnetic resonance angiography or digital subtraction angiography for ≥ 2 years after treatment. Results: The rate of total procedure-related complications was 19.8%. The rates of thromboembolic complications, hemorrhagic complications, and intraprocedural aneurysm bleeding were 12.5%, 6.3%, and 3.1%, respectively, with no poor outcomes (modified Rankin Scale score 2–6) resulting from thromboembolic and hemorrhagic complications at 180 days after treatment. The permanent morbidity rate was 1.0%. Multivariate analysis revealed that maximum diameter (>10 mm), neck size (>4 mm), and stent use were independently associated with symptomatic cerebral infarction. Endovascular retreatment was conducted for two aneurysms (2.6%), and the cumulative recanalization rate was 5.3% (4/76) over a mean follow-up period of 48.2 ± 23.7 months. Conclusion: This study indicates that although there is a relatively high possibility of overall procedure-related complications with endovascular treatment for unruptured AcomA aneurysms, most complications are temporary and mild, with a permanent morbidity rate of approximately 1.0%.