Safety and efficacy of anterior communicating artery compromise during endovascular coil embolization of adjoining aneurysms

Objective: In the presence of symmetric A₁ flow, the safety and efficacy of compromising the anterior communicating artery (ACoA) during coil embolization of ACoA aneurysms has yet to be evaluated. Herein, the authors describe their experience, focusing on procedural safety. Methods: Between October 2012 and July 2017, 285 ACoA aneurysms with symmetric A₁ flows were treated at the authors' institution by endovascular coil embolization. Clinical and angiographic outcome data were subjected to binary logistic regression analysis. Results: ACoA compromise was chosen in the treatment of 71 aneurysms (24.9%), which were completely (n = 15) or incompletely (n = 56) compromised. In the remaining 214 lesions, the ACoA was preserved. Although 9 patients (3.2%) experienced procedure-related thromboembolisms (compromised, 4; preserved, 5), all but 1 patient (with ACoA compromise) were asymptomatic. In multivariate analysis, subarachnoid hemorrhage at presentation was the sole independent risk factor for thromboembolism (OR 15.98, p < 0.01), with ACoA compromise being statistically unrelated. In 276 aneurysms (96.8%) with follow-up of > 6 months (mean 20.9 ± 13.1 months, range 6.54 months), recanalization was confirmed in 21 (minor, 15; major, 6). A narrow (≤ 4 mm) saccular neck (p < 0.01) and ACoA compromise (p = 0.04) were independently linked to prevention of recanalization. Conclusions: During coil embolization of ACoA aneurysms, the ACoA may be compromised without serious complications if A₁ flows are symmetric. This approach may also confer some long-term protection from recanalization, serving as a valid treatment option for such lesions.