Treatment of Ruptured Anterior Communicating Artery Aneurysms: Equipoise in the Endovascular Era?

Karam Moon, Michael R. Levitt, Rami O. Almefty, Peter Nakaji, Felipe C. Albuquerque, Joseph M. Zabramski, Cameron McDougall, Robert F. Spetzler

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Ruptured anterior communicating artery (ACoA) aneurysms are heterogeneous intracranial aneurysms whose diverse morphological features influence treatment modality. OBJECTIVE: To compare clinical outcomes and complications of all ruptured ACoA aneurysms treated by clipping or coiling in a modern institutional trial. METHODS: All patients with ruptured ACoA aneurysms in the Barrow Ruptured Aneurysm Trial were included. Clinical follow-up at 1 and 3 years was analyzed; charts were reviewed for patient demographics, aneurysm characteristics, and in-hospital complications. RESULTS: This cohort included 130 patients (mean age, 52.5 years). Mean aneurysm size was 5.8 mm. Most aneurysm domes projected anteriorly (n 52). After randomization and crossover, 91 ACoA aneurysms (70%) were clipped and 39 (30%) were coiled. Twenty-two patients (16.9%) initially randomized to coiling crossed over to clipping after evaluation. No patients crossed over from clipping to coiling. Characteristics precluding aneurysms from coiling included unfavorable dome-to-neck ratio, lesions difficult to access by catheter, and branch vessel involvement. Aneurysm size and dome projection were not significantly associated with treatment group, clinical outcome, or retreatment. No significant difference existed in clinical outcome (modified Rankin Scale scores) between groups at discharge or at 1-year or 3-year follow-up using as-treated and intention-to-treat analyses. Retreatment was performed in 3 clipped patients (2.3%) and 3 coiled patients (2.3%). CONCLUSION: Ruptured ACoA aneurysms, regardless of size and projection, were safely treated by both treatment modalities in a large-scale randomized clinical trial. Clinical outcomes and stroke rates did not differ significantly in as-treated or intention-to-treat analyses. ABBREVIATIONS: ACoA, anterior communicating artery BRAT, Barrow Ruptured Aneurysm Trial ITT, intention-to-treat mRS, modified Rankin Scale

Original languageEnglish (US)
Pages (from-to)566-571
Number of pages6
JournalNeurosurgery
Volume77
Issue number4
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Fingerprint

Ruptured Aneurysm
Intracranial Aneurysm
Aneurysm
Intention to Treat Analysis
Retreatment
Therapeutics
Arteries
Random Allocation
boldenone undecylenate
Neck
Catheters
Randomized Controlled Trials
Stroke
Demography

Keywords

  • Aneurysm
  • Anterior communicating artery
  • Clip occlusion
  • Coil embolization

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Moon, K., Levitt, M. R., Almefty, R. O., Nakaji, P., Albuquerque, F. C., Zabramski, J. M., ... Spetzler, R. F. (2015). Treatment of Ruptured Anterior Communicating Artery Aneurysms: Equipoise in the Endovascular Era? Neurosurgery, 77(4), 566-571. https://doi.org/10.1227/NEU.0000000000000878

Treatment of Ruptured Anterior Communicating Artery Aneurysms : Equipoise in the Endovascular Era? / Moon, Karam; Levitt, Michael R.; Almefty, Rami O.; Nakaji, Peter; Albuquerque, Felipe C.; Zabramski, Joseph M.; McDougall, Cameron; Spetzler, Robert F.

In: Neurosurgery, Vol. 77, No. 4, 01.01.2015, p. 566-571.

Research output: Contribution to journalArticle

Moon, K, Levitt, MR, Almefty, RO, Nakaji, P, Albuquerque, FC, Zabramski, JM, McDougall, C & Spetzler, RF 2015, 'Treatment of Ruptured Anterior Communicating Artery Aneurysms: Equipoise in the Endovascular Era?', Neurosurgery, vol. 77, no. 4, pp. 566-571. https://doi.org/10.1227/NEU.0000000000000878
Moon K, Levitt MR, Almefty RO, Nakaji P, Albuquerque FC, Zabramski JM et al. Treatment of Ruptured Anterior Communicating Artery Aneurysms: Equipoise in the Endovascular Era? Neurosurgery. 2015 Jan 1;77(4):566-571. https://doi.org/10.1227/NEU.0000000000000878
Moon, Karam ; Levitt, Michael R. ; Almefty, Rami O. ; Nakaji, Peter ; Albuquerque, Felipe C. ; Zabramski, Joseph M. ; McDougall, Cameron ; Spetzler, Robert F. / Treatment of Ruptured Anterior Communicating Artery Aneurysms : Equipoise in the Endovascular Era?. In: Neurosurgery. 2015 ; Vol. 77, No. 4. pp. 566-571.
@article{cee2a41e52d84df892bcfc41761d8136,
title = "Treatment of Ruptured Anterior Communicating Artery Aneurysms: Equipoise in the Endovascular Era?",
abstract = "BACKGROUND: Ruptured anterior communicating artery (ACoA) aneurysms are heterogeneous intracranial aneurysms whose diverse morphological features influence treatment modality. OBJECTIVE: To compare clinical outcomes and complications of all ruptured ACoA aneurysms treated by clipping or coiling in a modern institutional trial. METHODS: All patients with ruptured ACoA aneurysms in the Barrow Ruptured Aneurysm Trial were included. Clinical follow-up at 1 and 3 years was analyzed; charts were reviewed for patient demographics, aneurysm characteristics, and in-hospital complications. RESULTS: This cohort included 130 patients (mean age, 52.5 years). Mean aneurysm size was 5.8 mm. Most aneurysm domes projected anteriorly (n 52). After randomization and crossover, 91 ACoA aneurysms (70{\%}) were clipped and 39 (30{\%}) were coiled. Twenty-two patients (16.9{\%}) initially randomized to coiling crossed over to clipping after evaluation. No patients crossed over from clipping to coiling. Characteristics precluding aneurysms from coiling included unfavorable dome-to-neck ratio, lesions difficult to access by catheter, and branch vessel involvement. Aneurysm size and dome projection were not significantly associated with treatment group, clinical outcome, or retreatment. No significant difference existed in clinical outcome (modified Rankin Scale scores) between groups at discharge or at 1-year or 3-year follow-up using as-treated and intention-to-treat analyses. Retreatment was performed in 3 clipped patients (2.3{\%}) and 3 coiled patients (2.3{\%}). CONCLUSION: Ruptured ACoA aneurysms, regardless of size and projection, were safely treated by both treatment modalities in a large-scale randomized clinical trial. Clinical outcomes and stroke rates did not differ significantly in as-treated or intention-to-treat analyses. ABBREVIATIONS: ACoA, anterior communicating artery BRAT, Barrow Ruptured Aneurysm Trial ITT, intention-to-treat mRS, modified Rankin Scale",
keywords = "Aneurysm, Anterior communicating artery, Clip occlusion, Coil embolization",
author = "Karam Moon and Levitt, {Michael R.} and Almefty, {Rami O.} and Peter Nakaji and Albuquerque, {Felipe C.} and Zabramski, {Joseph M.} and Cameron McDougall and Spetzler, {Robert F.}",
year = "2015",
month = "1",
day = "1",
doi = "10.1227/NEU.0000000000000878",
language = "English (US)",
volume = "77",
pages = "566--571",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Treatment of Ruptured Anterior Communicating Artery Aneurysms

T2 - Equipoise in the Endovascular Era?

AU - Moon, Karam

AU - Levitt, Michael R.

AU - Almefty, Rami O.

AU - Nakaji, Peter

AU - Albuquerque, Felipe C.

AU - Zabramski, Joseph M.

AU - McDougall, Cameron

AU - Spetzler, Robert F.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - BACKGROUND: Ruptured anterior communicating artery (ACoA) aneurysms are heterogeneous intracranial aneurysms whose diverse morphological features influence treatment modality. OBJECTIVE: To compare clinical outcomes and complications of all ruptured ACoA aneurysms treated by clipping or coiling in a modern institutional trial. METHODS: All patients with ruptured ACoA aneurysms in the Barrow Ruptured Aneurysm Trial were included. Clinical follow-up at 1 and 3 years was analyzed; charts were reviewed for patient demographics, aneurysm characteristics, and in-hospital complications. RESULTS: This cohort included 130 patients (mean age, 52.5 years). Mean aneurysm size was 5.8 mm. Most aneurysm domes projected anteriorly (n 52). After randomization and crossover, 91 ACoA aneurysms (70%) were clipped and 39 (30%) were coiled. Twenty-two patients (16.9%) initially randomized to coiling crossed over to clipping after evaluation. No patients crossed over from clipping to coiling. Characteristics precluding aneurysms from coiling included unfavorable dome-to-neck ratio, lesions difficult to access by catheter, and branch vessel involvement. Aneurysm size and dome projection were not significantly associated with treatment group, clinical outcome, or retreatment. No significant difference existed in clinical outcome (modified Rankin Scale scores) between groups at discharge or at 1-year or 3-year follow-up using as-treated and intention-to-treat analyses. Retreatment was performed in 3 clipped patients (2.3%) and 3 coiled patients (2.3%). CONCLUSION: Ruptured ACoA aneurysms, regardless of size and projection, were safely treated by both treatment modalities in a large-scale randomized clinical trial. Clinical outcomes and stroke rates did not differ significantly in as-treated or intention-to-treat analyses. ABBREVIATIONS: ACoA, anterior communicating artery BRAT, Barrow Ruptured Aneurysm Trial ITT, intention-to-treat mRS, modified Rankin Scale

AB - BACKGROUND: Ruptured anterior communicating artery (ACoA) aneurysms are heterogeneous intracranial aneurysms whose diverse morphological features influence treatment modality. OBJECTIVE: To compare clinical outcomes and complications of all ruptured ACoA aneurysms treated by clipping or coiling in a modern institutional trial. METHODS: All patients with ruptured ACoA aneurysms in the Barrow Ruptured Aneurysm Trial were included. Clinical follow-up at 1 and 3 years was analyzed; charts were reviewed for patient demographics, aneurysm characteristics, and in-hospital complications. RESULTS: This cohort included 130 patients (mean age, 52.5 years). Mean aneurysm size was 5.8 mm. Most aneurysm domes projected anteriorly (n 52). After randomization and crossover, 91 ACoA aneurysms (70%) were clipped and 39 (30%) were coiled. Twenty-two patients (16.9%) initially randomized to coiling crossed over to clipping after evaluation. No patients crossed over from clipping to coiling. Characteristics precluding aneurysms from coiling included unfavorable dome-to-neck ratio, lesions difficult to access by catheter, and branch vessel involvement. Aneurysm size and dome projection were not significantly associated with treatment group, clinical outcome, or retreatment. No significant difference existed in clinical outcome (modified Rankin Scale scores) between groups at discharge or at 1-year or 3-year follow-up using as-treated and intention-to-treat analyses. Retreatment was performed in 3 clipped patients (2.3%) and 3 coiled patients (2.3%). CONCLUSION: Ruptured ACoA aneurysms, regardless of size and projection, were safely treated by both treatment modalities in a large-scale randomized clinical trial. Clinical outcomes and stroke rates did not differ significantly in as-treated or intention-to-treat analyses. ABBREVIATIONS: ACoA, anterior communicating artery BRAT, Barrow Ruptured Aneurysm Trial ITT, intention-to-treat mRS, modified Rankin Scale

KW - Aneurysm

KW - Anterior communicating artery

KW - Clip occlusion

KW - Coil embolization

UR - http://www.scopus.com/inward/record.url?scp=84941926870&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84941926870&partnerID=8YFLogxK

U2 - 10.1227/NEU.0000000000000878

DO - 10.1227/NEU.0000000000000878

M3 - Article

C2 - 26308643

AN - SCOPUS:84941926870

VL - 77

SP - 566

EP - 571

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 4

ER -