126 Neurosurgical Clipping Versus Endovascular Coiling for Unruptured and Ruptured Distal Anterior Cerebral Artery Aneurysms: A Systematic Review and Meta-Analysis

Abstract Aim To assess outcomes after clipping or coiling of distal anterior cerebral artery (DACA) aneurysms via a meta-analysis. Method Systematic searches of Medline, Embase and Cochrane Central were undertaken from 1st January 1973 until 1st May 2020 for published studies reporting microsurgical clipping and endovascular coiling of DACA aneurysms. Primary outcome measure was independent functional outcome (modified Rankin scale (mRS) 0–2, or Glasgow Outcome Scale (GOS) 4–5). Secondary outcomes were poor clinical outcome and mortality, perioperative complications, aneurysm occlusion rates, rebleeding and recurrence. Results 938 and 223 patients with ruptured and unruptured DACA aneurysms, respectively, were reported across 28 studies. Pooled rate of procedure-related morbidity was 6.8% (95%CI: 3.2 – 11.2) and 1.3% (95%CI: 0.0 – 9.1) for clipped and coiling ruptured DACA aneurysms respectively. Pooled rate of intraoperative rupture for clipped and coiled ruptured DACA aneurysms was 10.0% (95%CI: 2.5 – 20.6) and 5.7% (95%CI: 1.1 – 12.5) respectively. Pooled rate of acute hydrocephalus for clipped and coiled ruptured DACA aneurysms was 7.8% (95%CI: 0.5 – 19.7) and 1.4% (95% CI: 0.0 – 11.3) respectively. Pooled rate of perioperative mortality was 0.002% (95% CI: 0.0 – 0.7) ruptured DACA aneurysms treated by clipping. For clipped unruptured DACA aneurysms, pooled rates of procedure-related morbidity, intraoperative rupture, acute hydrocephalus were 2.5% (95%CI: 0.0 – 7.5), 0.002% (95%CI: 0.0 – 3.1) and 0.5% (95%CI: 0.0 – 5.1) respectively. Conclusions Clipping results in poorer short-term outcomes when compared to coiling. However, the final decision-making should be shared with the patient and be performed on a selective, case-by-case basis in order to maximize patient benefits.

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Neurosurgical clipping versus endovascular coiling for unruptured and ruptured distal anterior cerebral artery aneurysms: a systematic review and meta-analysis

Brain and Spine ◽

10.1016/j.bas.2021.100318 ◽

2021 ◽

Vol 1 ◽

pp. 100318

Author(s):

K. Lee ◽

J.J.Y. Zhang ◽

M. Teo

Keyword(s):

Systematic Review ◽

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Meta Analysis ◽

Endovascular Coiling ◽

Distal Anterior Cerebral Artery

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Safety and Efficacy of Surgical and Endovascular Treatment for Distal Anterior Cerebral Artery Aneurysms: A Systematic Review and Meta-Analysis

World Neurosurgery ◽

10.1016/j.wneu.2016.11.134 ◽

2017 ◽

Vol 100 ◽

pp. 557-566 ◽

Cited By ~ 17

Author(s):

Ondra Petr ◽

Lucie Coufalová ◽

Ondřej Bradáč ◽

Rafael Rehwald ◽

Berharnd Glodny ◽

...

Keyword(s):

Systematic Review ◽

Endovascular Treatment ◽

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Meta Analysis ◽

Safety And Efficacy ◽

Distal Anterior Cerebral Artery

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Contemporary Management of Distal Anterior Cerebral Artery Aneurysms: A Dual-Trained Neurosurgeon's Perspective

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0041-1735823 ◽

2021 ◽

Author(s):

Sunil V. Furtado ◽

Dravya Jayakumar ◽

Parichay J. Perikal ◽

Dilip Mohan

Keyword(s):

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Statistical Significance ◽

Endovascular Coiling ◽

World Federation ◽

Anterior Circulation ◽

Chi Square ◽

Good Outcome ◽

Fisher Grade ◽

Distal Anterior Cerebral Artery

Abstract Objectives Distal anterior cerebral artery (DACA) aneurysms are a subset of aneurysms located in the anterior circulation but away from the circle of Willis. We analyze the clinical presentation and outcomes of two treatment groups—surgical and endovascular—for DACA aneurysms managed by a dual-trained neurosurgeon. Material and Methods A retrospective evaluation of radiological and operative/interventional data of 34 patients with 35 DACA aneurysms over a 12-year period was analyzed. Twenty-seven patients underwent surgery, whereas seven underwent endovascular coiling of the aneurysms. Modified Fisher grade and World Federation of Neurosurgical Societies scale (WFNS) were used to note the subarachnoid hemorrhage (SAH) severity. Statistical Analysis Categorical data were presented as frequency and percentage, while noncategorical data were represented as mean ± SD. Statistical significance for difference in outcome between the two groups was analyzed using Chi-square test, and p < 0.05 was considered statistically significant. Results Of 34 patients, 33 presented with a bleed and 23.5% patients were noted to have another aneurysm in addition to the DACA aneurysm. Patients who underwent clipping for another aneurysm along with the DACA aneurysm in a single surgical exercise had a poor outcome compared with those who underwent surgery for the lone DACA aneurysm (7 vs. 20, p = 0.015). Most patients in both surgical (70.37%) and endovascular (85.71%) groups had good outcome (mRS ≤ 2). Conclusions A good outcome can be achieved with either surgery or endovascular coiling in the management of DACA aneurysms. In patients with multiple aneurysms, SAH with aneurysmal rupture of DACA should be managed first; the other unruptured aneurysm may be operated after an interval to avoid morbidity.

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Abstract TP428: Microsurgical and Endovascular Treatment of Ruptured Distal Anterior Cerebral Artery Aneurysms

Stroke ◽

10.1161/str.44.suppl_1.atp428 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Keun Young Park ◽

Yoon Ho Lee ◽

Eun Hyun Ihm ◽

Yong Cheol Lim ◽

Joonho Chung ◽

...

Keyword(s):

Endovascular Treatment ◽

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Ct Scanning ◽

Endovascular Coiling ◽

Surgical Morbidity ◽

Technical Success Rate ◽

Microsurgical Clipping ◽

Maximal Diameter ◽

Distal Anterior Cerebral Artery

Introduction: Distal anterior cerebral artery (DACA) aneurysms are less common and surgical morbidity has been reported relatively high due to intraoperative rupture and narrow surgical field. Endovascular treatment can be alternative to surgery. This study investigated the efficacy and safety of endovascular coiling for ruptured DACA aneurysms comparing with microsurgical clipping. Patients and Methods: Between January 1999 and March 2012, consecutive 94 patients with ruptured DACA aneurysm were treated by surgical clipping (n=52, 55.3%) and endovascular coiling (n=42, 44.7%) in five institutions including only 2 cases of recurrence (2.1%, 1 in clip and 1 in coil). The clinical outcomes of patients and procedure-related complications (intraprocedural rupture and any infarction) were evaluated and compared between two groups. Results: There were 38 males and 56 females (mean age; 55.1 years). Initial Hunt-Hess grade was GII in 25 patients (37.2%), GIII in 36 patients (38.3%), GIV in 12 patients (12.8%), and GV in 11 patients (11.7%), which was significantly higher in coil group (2.77 in clip vs 3.26 in coil, p=0.016). Initial CT scanning showed ruptured DACA aneurysm with ICH (n=35; 37.2%) and hydrocephalus (n=25; 26.6%). Maximal diameter of aneurysm was less than 5mm in 36 (38.3%), 5~10mm in 53 (56.4%), and 10mm and more than in 5 (5.3%). Technical success rate was 100% and complete occlusion or neck remnant of aneurysm was achieved in 87 [92.6%, 49 (96.1%) in clip vs 38 (90.5%) in coil, p=0.404] and incomplete in 6 (6.4%). At discharge, favorable outcome (modified GOS; good and fair) was obtained in 70 [77.8%, 44 (84.6%) in clip vs 26 (68.4%) in coil, p=0.078]. Intraprocedural rupture occurred only in clipping group [6 cases (11.5%), p=0.031]. Any procedure-related infarction occurred in 7 [7.4%, 6 (11.5%) in clip vs 1 (2.4%) in coil, p=0.126]. Intraprocedural thrombus was detected in 5 cases of coil group and most of them were restored by thrombolytic therapy. There was one case of acute rebleeding in coiling group and this patient died. Conclusions: Endovascular coiling was comparable treatment with clipping for ruptured DACA aneurysms.

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Distal Anterior Cerebral Artery Aneurysms: Advantages of Bifrontal Basal Anterior Interhemispheric Approach Over Unilateral Approach

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0033-1336206 ◽

2013 ◽

Vol 74 (S 01) ◽

Author(s):

Rajesh Chhabra ◽

Sunil Gupta ◽

Sandeep Mohindra ◽

N. Khandelwal

Keyword(s):

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Unilateral Approach ◽

Interhemispheric Approach ◽

Anterior Interhemispheric Approach ◽

Distal Anterior Cerebral Artery

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Occlusion of an “accessory” distal anterior cerebral artery during treatment of anterior communicating artery aneurysms

Journal of Neurosurgery ◽

10.3171/jns.1991.74.1.0133 ◽

1991 ◽

Vol 74 (1) ◽

pp. 133-135 ◽

Cited By ~ 5

Author(s):

Kevin Gibbons ◽

Leo N. Hopkins ◽

Roberto C. Heros

Keyword(s):

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Anterior Communicating Artery ◽

Case Histories ◽

Content Type ◽

Anterior Communicating Artery Aneurysms ◽

Artery Segment ◽

Distal Anterior Cerebral Artery ◽

Clip Occlusion ◽

Fine Print

✓ Two cases are presented in which clip occlusion of a third distal anterior cerebral artery segment occurred during treatment of anterior communicating artery aneurysms. Case histories, angiograms, operative descriptions, and postmortem findings are presented. The incidence of this anomalous vessel is reviewed. Preoperative and intraoperative vigilance in determining the presence of this anomaly prior to clip placement is emphasized.

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