title: Impact of anatomic features in the endovascular embolization of 181 anterior communicating artery aneurysms.
abstract: OBJECTIVE
  We analyzed the impact of detailed anatomic characteristics on the results of endovascular coil embolization for anterior communicating artery (AcoA) aneurysms and developed a predictive model estimating the probability of successful endovascular treatment.
  
  
  METHODS
  One hundred eighty-one AcoA aneurysms were treated with endovascular coil embolization between August 1991 and November 2005. Morphological characteristics that were analyzed included direction of the dome, location of the neck, association with hypoplasia or aplasia of AcoA complex vessels, sac, and neck size. Immediate clinical and anatomic results, long-term morbidity/mortality, recanalization rate, and delayed aneurysm thrombosis were analyzed. ORs were calculated for each anatomic and clinical result and logistic regression was used in formulating a predictive model.
  
  
  RESULTS
  There were 115 females and 66 males. Age range was 9 to 86 years (mean 57). Factors significantly associated with complete embolization included small aneurysms (<10 mm), small neck (<4 mm), and anterior dome orientation. Factors significantly associated with aneurysm recanalization after long-term follow-up included aneurysm domes >10 mm, neck location on the AcoA, posterior dome orientation, and incomplete original embolization. Globally, the majority of patients remained neurologically intact or unchanged after the procedure (92.8%). Mortality was significantly influenced by the preoperative condition of the patient. The predictive model successfully represented the likely outcomes based on morphological features.
  
  
  CONCLUSIONS
  AcoA aneurysm coil embolization can be safely performed with acceptable rates of morbidity. Dome and neck orientation, sack and neck size, sac-to-neck ratio, and associated anomalies should be considered to accurately assess the probability of successful treatment for AcoA aneurysms.
authors.affiliation: Division of Neurosurgery, UCLA Medical Center, Los Angeles, California 90095-7039, USA. ngonzalez@mednet.ucla.edu
authors.forename: Nestor
authors.initials: N
authors.lastname: Gonzalez
authors.forename: Mark
authors.initials: M
authors.lastname: Sedrak
authors.forename: Neil
authors.initials: N
authors.lastname: Martin
authors.forename: Fernando
authors.initials: F
authors.lastname: Vinuela
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D002648:Child; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome