Fast Transition from Open Surgery to Endovascular Treatment of Unruptured Anterior Communicating Artery Aneurysmse-A Retrospective Analysis of 128 Patients

OBJECTIVE: Anterior communicating artery aneurysms (ACoAAs) are challenging to treat both surgically and endovascularly. In this study, we evaluate the treatment-related morbidity and clinical outcome of microsurgical clipping and endovascular treatment for a consecutive series of unruptured ACoAAs while the treatment paradigm was in transition from surgical to endovascular first.

METHODS: We retrospectively reviewed clinical and radiological data of adult patients who underwent microsurgical clipping or endovascular treatment of an unruptured ACoAAs at a high-volume academic neurovascular center (Helsinki University Hospital) during 2012-2019. During this period, a transition from microsurgical clipping to endovascular treatment took place. Regarding outcome, we focused on treatment-related complications, discharge-to-home rates, functional performance (modified Rankin Scale), and obliteration rates.

RESULTS: Of 128 treated ACoAAs, 81 (64%) were treated surgically and 47 (36%) endovascularly. There was no difference in major complications, intracranial hemorrhagic complications or ischemic complications, discharge-to-home rates, or functional performance between the surgically and endovascularly treated patients. With time, a decrease in major complications was observed in the surgical cases (from 29% to 17%), while the major complication rate increased in the endovascularly patients (from 0% to 25%). Cerebral ischemia was the most frequent complication on both groups.. The risk for permanent neurological deficit remained low in both groups (9% for endovascular, 5% for surgery).

CONCLUSIONS: We did not find any major differences regarding complications and outcomes following the treatment paradigm shift from clipping to endovascular of unruptured ACoAAs. Prospective studies evaluating treatments' durability are needed to compare overall effectiveness.