The Safety and Efficacy of Endovascular Treatment for Very Small Ruptured Anterior Communicating Artery Aneurysms: A Large Single-Center Experience With 81 Consecutive Cases

OBJECTIVE: This study aimed to investigate the safety and efficacy of endovascular embolization for very small ruptured anterior communicating artery (AcomA) aneurysms. METHODS: From August 2015 to June 2020, 81 patients with very small (3 pound mm) ruptured AcomA aneurysms treated endovascularly were enrolled in this study. Clinical and radiographic data were analyzed retrospectively, including the aneurysm occlusion rate, complications, and clinical outcome. RESULTS: Among 81 patients, simple coiling embolization was performed in 52 cases and stent-assisted embolization in 29 cases. Immediate angiography demonstrated complete occlusion in 59 (72.8%) aneurysms, residual neck in 20(24.7%) aneurysms, and residual lumen in 2 (2.5%). Procedure-related complications rate was 2.5% (2 of 81), all of which were transient thromboembolic events. Angiographic follow-up outcomes of 60 patients (mean: 6.8 +/- 3.2 months) revealed complete occlusion in 91.7% (55 of 60), with recurrence in 1 patient. The mean clinical follow-up time was 22.6 +/- 11.4 months and good prognosis rates (6-month modified Rankin Scale score: 0e2) reached 90.2% (73 of 81). The differences in aneurysm occlusion and procedure-related complications between the simple coiling group and the stent-assisted coiling group were not statistically significant. CONCLUSIONS: Coiling with or without stent-assisted technique for the treatment of very small ruptured AcomA aneurysms was safe and effective.