Hiroki Kobayashi
International Medical Center, Saitama Medical University, Japan
Title: Clinical features and treatment outcome of ruptured distal ACA aneurysm
Biography
Biography: Hiroki Kobayashi
Abstract
Background: Aneurysms of the distal anterior cerebral artery (ACA) are rare, representing between 1% and 9% of all intracranial aneurysms. The best treatment strategy for these aneurysms continues to be debated.
Objective: To clarify the clinical features and treatment outcome of ruptured distal ACA aneurysms treated at our institute.
Methods: Between 2012 and 2018, a total of 37 consecutive patients (26 women; mean age, 65.2 years) with ruptured distal ACA aneurysms underwent surgical clipping or coil embolization at our institute. Clinical presentations, radiographic findings, and outcomes were reviewed retrospectively. Additionally, we analyzed risk factors of poor outcome (mRS 4-6) using multiple regression analysis.
Results: Nineteen patients (51.4%) were W.F.N.S grade IV-V, and frontal lobe hematomas occurred in 18 patients (48.7%). Five patients (13.5%) and thirteen patients (35.1%) manifested azygous or bihemispheric ACA and multiple aneurysms, respectively. Surgical clipping and endovascular coiling were performed in 28 patients (75.7%) and in 9 patients (24.3%) respectively, and aneurysms located at the A4-5 portions were mainly treated by surgical clipping (p=0.04). There were no statistical differences in procedure-related morbidity and mortality between those groups, but complete occlusion rate was higher in the surgical group (p<0.01). Favorable neurological outcome at discharge (mRS 0-3) was obtained in 23 patients (62.5%), and multiple regression analysis revealed W.F.N.S grade IV-V and frontal lobe hematomas were risk factors of poor outcome.
Conclusion: Our treatment result using surgical clipping and endovascular coiling was acceptable and poor W.F.N.S grade and frontal lobe hematoma were risk factors of poor prognosis.