Abstract 1122‐000087: Long‐Term Outcomes of Anterior Communicating Artery Aneurysm Treated with Coiling: Subset Analysis of SMART Registry

Introduction : The purpose of this study was to assess the long‐term clinical outcomes of anterior communicating artery (ACoA) aneurysm treated with coiling. Methods : Data on patients with an ACoA aneurysm were extracted from a prospective multicenter registry (SMART) that enrolled patients with intracranial aneurysms or other neurovascular abnormalities who underwent coiling. The primary effectiveness outcome was retreatment through follow‐up, and the primary safety outcome was procedural device‐related serious adverse events within 24 hours. Results : Of the 995 adults enrolled in the SMART registry, 230 had an ACoA aneurysm (Table). The average patient age was 59.1 years (SD 12.5), and 62.6% were female. A modified Rankin Scale score of 0 to 2 was present in 89.6% of patients. Most aneurysms were small (93.9%) and saccular (87.8%). The aneurysm was wide necked in 57.7% of patients and was ruptured in 35.7%. Coiling was stent assisted in 39.1% of patients and balloon assisted in 14.8%. Retreatment through follow‐up occurred in 8.1% (15/185) of patients—6.8% (12/176) of patients with a small aneurysm, 33.3% (3/9) of patients with a large aneurysm, 4.0% (5/126) of patients with an unruptured aneurysm, 16.9% (10/59) of patients with a ruptured aneurysm, 9.9% (9/91) of patients with unassisted coiling, 5.6% (4/71) of patients with stent‐assisted coiling, and 7.4% (2/27) of patients with balloon‐assisted coiling. Procedural device‐related serious adverse events within 24 hours occurred in 5.2% of patients—5.1% (11/216) of patients with a small aneurysm, 7.1% (1/14) of patients with a large aneurysm, 6.1% (9/148) of patients with an unruptured aneurysm, 3.7% (3/82) of patients with a ruptured aneurysm, 3.6% (4/111) of patients with unassisted coiling, 5.6% (5/90) of patients with stent‐assisted coiling, and 11.8% (4/34) of patients with balloon‐assisted coiling. No deaths occurred within 24 hours of the procedure. At 1 year, 91.8% (167/182) of patients had a Raymond–Roy Occlusion Classification of Class I or II. From immediately after the procedure to 1 year, progressive occlusion was observed in 29.1% (53/182) of patients, and stable occlusion was observed in 56.6% (103/182) of patients. At 1 year, the all‐cause mortality rate was 4.3%, and at a 1‐year follow‐up, a modified Rankin Scale score of 0 to 2 was present in 86.2% (112/130) of patients. Conclusions : Coiling of ACoA aneurysm was safe and had durable 1‐year results.

Balloon-Catheter Buddy Technique for Coiling of Very Small Aneurysm

The catheter movement and stability in coiling of very small aneurysms is challenging. We describe a technique for controlled catheter movement and successful coiling of a very small aneurysm.

Acute Aneurysmal Subarachnoid Haemorrhage following Coital Headache successfully treated with Endovascular Flow Diversion

Headache associated with sexual activity is a difficult diagnosis for physicians and sometimes underlies grave etiologies. One such cause associated with high morbidity and mortality is subarachnoid hemorrhage due to aneurysm rupture. This is a case of a 39 year old male, presenting with coital headache for few episodes. CT showed subarachnoid hemorrhage, Fischer Grade 3. Digital subtraction angiography revealed Right Internal carotid artery very small aneurysm which was endovascularly managed with FRED (flow-redirection endoluminal device, Microvention, Aliso Viejo, California, USA) flow diverter placement across the aneurysm. Follow up revealed complete resolution of aneurysm with no residual clinical symptoms. The following case reveals the importance of identifying sexual headache as a presenting symptom of grave etiology like aneurysmal rupture and its early diagnosis and management to avoid mortality.

The mechanical thrombectomy during coil embolisation of the ruptured intracranial aneurysm

Experience in managing thromboembolic complications of distal blood vessels during coil embolization in the case of subarachnoid hemorrhage (SAH) is still limited. This is the presentation of the case of a 23-year-old man with a ruptured small aneurysm who experienced thromboembolic occlusion during coil embolization. Mechanical thrombectomy resulted in complete recanalization of the occluded branches without ischemic complications. This case should be used for the use of mechanical thrombectomies as an effective rescue strategy and treatment of distal arteries occlusions of the brain.