title: Rates of local procedural-related structural injury following clipping or coiling of anterior communicating artery aneurysms.
abstract: BACKGROUND
  Surgical clipping and endovascular coiling yield similar functional outcomes for the treatment of saccular aneurysms of the anterior communicating (ACOM) artery. However, surgical treatment may be associated with greater rates of cognitive impairment due to injury of adjacent structures. We aimed to quantify the rates of injury (infarction/hemorrhage) for both clipping and coiling of ACOM aneurysms.
  
  
  METHODS
  This was a retrospective dual-center radiological investigation of a consecutive series of patients with ruptured and unruptured ACOM aneurysms treated between January 2011 and October 2014. Post-treatment CT or MRI was assessed for new ischemic or hemorrhagic injury. Injury relating to the primary hemorrhage or vasospasm was differentiated. Univariate analysis using χ(2) tests and multivariate analysis using binary logistic regression was used.
  
  
  RESULTS
  66 patients treated with clipping were compared with 93 patients treated with coiling. 32/66 (48.5%) patients in the clipping group suffered treatment-related injury (31 ischemic, 1 hemorrhagic) compared with 4/93 (4.4%) patients in the coiling group (3 ischemic, 1 hemorrhagic) (p<0.0001). For patients with subarachnoid hemorrhage, the multivariate OR for infarction for clipping over coiling was 24.42 (95% CI 5.84 to 102.14), p<0.0001. The most common site of infarction was the basal forebrain (28/66 patients, 42.4%), with bilateral infarction in 4. There was injury of the septal/subcallosal region in 12/66 patients (18%).
  
  
  CONCLUSIONS
  Clipping of ACOM aneurysms is associated with significantly higher rates of structural injury than coiling, and this may be a reason for superior cognitive outcomes in patients treated with coiling in previously published studies.
authors: Department of Radiology, Royal North Shore Hospital, Sydney, Australia.
authors: Alex M
authors: AM
authors: Mortimer
authors: Department of Radiology, Royal North Shore Hospital, Sydney, Australia Department of Neurosurgery, Westmead Hospital, Sydney, Australia.
authors: Brendan
authors: B
authors: Steinfort
authors: Department of Radiology, Royal North Shore Hospital, Sydney, Australia Department of Neurosurgery, Westmead Hospital, Sydney, Australia.
authors: Ken
authors: K
authors: Faulder
authors: Department of Radiology, Royal North Shore Hospital, Sydney, Australia.
authors: Tian
authors: T
authors: Erho
authors: University of Sydney, Sydney, Australia.
authors: Daniel B
authors: DB
authors: Scherman
authors: Department of Neurosurgery, Westmead Hospital, Sydney, Australia.
authors: Prashanth J
authors: PJ
authors: Rao
authors: Department of Radiology, Royal North Shore Hospital, Sydney, Australia.
authors: Timothy
authors: T
authors: Harrington
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging* / Q000601:surgery; D057510:Endovascular Procedures / Q000009:adverse effects / Q000639:trends*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery; D007431:Intraoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013525:Surgical Instruments / Q000009:adverse effects / Q000639:trends*
keywords: Aneurysm; CT; Coil; Stroke; Technique