Feasibility and limitations of endovascular coil embolization of anterior communicating artery aneurysms: Morphological considerations

John K. Birknes, Sung Kyun Hwang, Aditya S. Pandey, Kevin Cockroft, Anne Marie Dyer, Ronald P. Benitez, Erol Veznedaroglu, Robert H. Rosenwasser

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

OBJECTIVE: The purpose of this study is to analyze anterior communicating artery (AComA) aneurysm morphology and its relationship to the limitations and feasibility of endovascular coil embolization. METHODS: One hundred twenty-three patients were treated with endovascular coil embolization for AComA aneurysms. Aneurysm morphology was classified into six categories according to the projection of the aneurysm (anterior, posterior/superior, or inferior) and neck size (< 4 mm or ≥ 4 mm). The following categories were used: Class A1, anterior projection and neck of aneurysm less than 4 mm; Class A2, anterior projection and neck of aneurysm 4 mm or more; Class B1, posterior (superior) projection and neck of aneurysm less than 4 mm; Class B2, posterior (superior) projection and neck of aneurysm 4 mm or more; Class C1, inferior projection and neck of aneurysm less than 4 mm; and Class C2, inferior projection and neck of aneurysm 4 mm or more. Endovascular procedures were categorized as either successful or unsuccessful according to specific criteria. In addition, patients were followed for recanalization. Clinical follow-up data was obtained at discharge and after 6 months and was classified according to the Glasgow Outcome Scale. RESULTS: Complete or near complete aneurysm occlusion was observed in 108 (88%) patients, partial embolization was performed in three (2.4%) patients, and embolization was attempted in 12 (9.7%) patients. Successful embolization for AComA aneurysms was performed in 86 out of 123 (70%) patients or 77.5% (86 out of 111 patients) of those patients in whom embolization was possible. Statistical analysis demonstrated that anterior projecting aneurysms were more likely to be successfully coiled than either inferior or posterior/superior directed AComA aneurysms. In addition, inferiorly projecting AComA aneurysms and wide-neck aneurysms had a significantly higher rate of recanalization. CONCLUSION: Endovascular coil embolization of AComA aneurysms shows good outcome in our study. Despite advanced modern techniques, there are limitations in the endovascular approach to AComA aneurysms. Consideration of aneurysm morphology may be used to guide approaches in the treatment of AComA aneurysms.

Original languageEnglish (US)
Pages (from-to)43-51
Number of pages9
JournalNeurosurgery
Volume59
Issue number1
DOIs
StatePublished - Jul 1 2006

Fingerprint

Intracranial Aneurysm
Aneurysm
Neck
Glasgow Outcome Scale
Endovascular Procedures
varespladib methyl

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Birknes, John K. ; Hwang, Sung Kyun ; Pandey, Aditya S. ; Cockroft, Kevin ; Dyer, Anne Marie ; Benitez, Ronald P. ; Veznedaroglu, Erol ; Rosenwasser, Robert H. / Feasibility and limitations of endovascular coil embolization of anterior communicating artery aneurysms : Morphological considerations. In: Neurosurgery. 2006 ; Vol. 59, No. 1. pp. 43-51.
@article{bd61b483b65c4cf0a14a9ab6a79efe43,
title = "Feasibility and limitations of endovascular coil embolization of anterior communicating artery aneurysms: Morphological considerations",
abstract = "OBJECTIVE: The purpose of this study is to analyze anterior communicating artery (AComA) aneurysm morphology and its relationship to the limitations and feasibility of endovascular coil embolization. METHODS: One hundred twenty-three patients were treated with endovascular coil embolization for AComA aneurysms. Aneurysm morphology was classified into six categories according to the projection of the aneurysm (anterior, posterior/superior, or inferior) and neck size (< 4 mm or ≥ 4 mm). The following categories were used: Class A1, anterior projection and neck of aneurysm less than 4 mm; Class A2, anterior projection and neck of aneurysm 4 mm or more; Class B1, posterior (superior) projection and neck of aneurysm less than 4 mm; Class B2, posterior (superior) projection and neck of aneurysm 4 mm or more; Class C1, inferior projection and neck of aneurysm less than 4 mm; and Class C2, inferior projection and neck of aneurysm 4 mm or more. Endovascular procedures were categorized as either successful or unsuccessful according to specific criteria. In addition, patients were followed for recanalization. Clinical follow-up data was obtained at discharge and after 6 months and was classified according to the Glasgow Outcome Scale. RESULTS: Complete or near complete aneurysm occlusion was observed in 108 (88{\%}) patients, partial embolization was performed in three (2.4{\%}) patients, and embolization was attempted in 12 (9.7{\%}) patients. Successful embolization for AComA aneurysms was performed in 86 out of 123 (70{\%}) patients or 77.5{\%} (86 out of 111 patients) of those patients in whom embolization was possible. Statistical analysis demonstrated that anterior projecting aneurysms were more likely to be successfully coiled than either inferior or posterior/superior directed AComA aneurysms. In addition, inferiorly projecting AComA aneurysms and wide-neck aneurysms had a significantly higher rate of recanalization. CONCLUSION: Endovascular coil embolization of AComA aneurysms shows good outcome in our study. Despite advanced modern techniques, there are limitations in the endovascular approach to AComA aneurysms. Consideration of aneurysm morphology may be used to guide approaches in the treatment of AComA aneurysms.",
author = "Birknes, {John K.} and Hwang, {Sung Kyun} and Pandey, {Aditya S.} and Kevin Cockroft and Dyer, {Anne Marie} and Benitez, {Ronald P.} and Erol Veznedaroglu and Rosenwasser, {Robert H.}",
year = "2006",
month = "7",
day = "1",
doi = "10.1227/01.NEU.0000219220.25721.B9",
language = "English (US)",
volume = "59",
pages = "43--51",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

Feasibility and limitations of endovascular coil embolization of anterior communicating artery aneurysms : Morphological considerations. / Birknes, John K.; Hwang, Sung Kyun; Pandey, Aditya S.; Cockroft, Kevin; Dyer, Anne Marie; Benitez, Ronald P.; Veznedaroglu, Erol; Rosenwasser, Robert H.

In: Neurosurgery, Vol. 59, No. 1, 01.07.2006, p. 43-51.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Feasibility and limitations of endovascular coil embolization of anterior communicating artery aneurysms

T2 - Morphological considerations

AU - Birknes, John K.

AU - Hwang, Sung Kyun

AU - Pandey, Aditya S.

AU - Cockroft, Kevin

AU - Dyer, Anne Marie

AU - Benitez, Ronald P.

AU - Veznedaroglu, Erol

AU - Rosenwasser, Robert H.

PY - 2006/7/1

Y1 - 2006/7/1

N2 - OBJECTIVE: The purpose of this study is to analyze anterior communicating artery (AComA) aneurysm morphology and its relationship to the limitations and feasibility of endovascular coil embolization. METHODS: One hundred twenty-three patients were treated with endovascular coil embolization for AComA aneurysms. Aneurysm morphology was classified into six categories according to the projection of the aneurysm (anterior, posterior/superior, or inferior) and neck size (< 4 mm or ≥ 4 mm). The following categories were used: Class A1, anterior projection and neck of aneurysm less than 4 mm; Class A2, anterior projection and neck of aneurysm 4 mm or more; Class B1, posterior (superior) projection and neck of aneurysm less than 4 mm; Class B2, posterior (superior) projection and neck of aneurysm 4 mm or more; Class C1, inferior projection and neck of aneurysm less than 4 mm; and Class C2, inferior projection and neck of aneurysm 4 mm or more. Endovascular procedures were categorized as either successful or unsuccessful according to specific criteria. In addition, patients were followed for recanalization. Clinical follow-up data was obtained at discharge and after 6 months and was classified according to the Glasgow Outcome Scale. RESULTS: Complete or near complete aneurysm occlusion was observed in 108 (88%) patients, partial embolization was performed in three (2.4%) patients, and embolization was attempted in 12 (9.7%) patients. Successful embolization for AComA aneurysms was performed in 86 out of 123 (70%) patients or 77.5% (86 out of 111 patients) of those patients in whom embolization was possible. Statistical analysis demonstrated that anterior projecting aneurysms were more likely to be successfully coiled than either inferior or posterior/superior directed AComA aneurysms. In addition, inferiorly projecting AComA aneurysms and wide-neck aneurysms had a significantly higher rate of recanalization. CONCLUSION: Endovascular coil embolization of AComA aneurysms shows good outcome in our study. Despite advanced modern techniques, there are limitations in the endovascular approach to AComA aneurysms. Consideration of aneurysm morphology may be used to guide approaches in the treatment of AComA aneurysms.

AB - OBJECTIVE: The purpose of this study is to analyze anterior communicating artery (AComA) aneurysm morphology and its relationship to the limitations and feasibility of endovascular coil embolization. METHODS: One hundred twenty-three patients were treated with endovascular coil embolization for AComA aneurysms. Aneurysm morphology was classified into six categories according to the projection of the aneurysm (anterior, posterior/superior, or inferior) and neck size (< 4 mm or ≥ 4 mm). The following categories were used: Class A1, anterior projection and neck of aneurysm less than 4 mm; Class A2, anterior projection and neck of aneurysm 4 mm or more; Class B1, posterior (superior) projection and neck of aneurysm less than 4 mm; Class B2, posterior (superior) projection and neck of aneurysm 4 mm or more; Class C1, inferior projection and neck of aneurysm less than 4 mm; and Class C2, inferior projection and neck of aneurysm 4 mm or more. Endovascular procedures were categorized as either successful or unsuccessful according to specific criteria. In addition, patients were followed for recanalization. Clinical follow-up data was obtained at discharge and after 6 months and was classified according to the Glasgow Outcome Scale. RESULTS: Complete or near complete aneurysm occlusion was observed in 108 (88%) patients, partial embolization was performed in three (2.4%) patients, and embolization was attempted in 12 (9.7%) patients. Successful embolization for AComA aneurysms was performed in 86 out of 123 (70%) patients or 77.5% (86 out of 111 patients) of those patients in whom embolization was possible. Statistical analysis demonstrated that anterior projecting aneurysms were more likely to be successfully coiled than either inferior or posterior/superior directed AComA aneurysms. In addition, inferiorly projecting AComA aneurysms and wide-neck aneurysms had a significantly higher rate of recanalization. CONCLUSION: Endovascular coil embolization of AComA aneurysms shows good outcome in our study. Despite advanced modern techniques, there are limitations in the endovascular approach to AComA aneurysms. Consideration of aneurysm morphology may be used to guide approaches in the treatment of AComA aneurysms.

UR - http://www.scopus.com/inward/record.url?scp=33745766265&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33745766265&partnerID=8YFLogxK

U2 - 10.1227/01.NEU.0000219220.25721.B9

DO - 10.1227/01.NEU.0000219220.25721.B9

M3 - Article

C2 - 16823299

AN - SCOPUS:33745766265

VL - 59

SP - 43

EP - 51

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 1

ER -