The Relationships between Anatomical Factors and Treatment Procedures for the Endovascular Treatment of Anterior Communicating Artery Aneurysms

OBJECTIVE: Endovascular treatment of anterior communicating artery aneurysms is difficult due to their complex anatomical structure. We retrospectively analyzed the relationships among the anatomical features, initial microcatheter positions, and initial occlusion outcomes. METHODS: In all, 66 cases were treated at our hospital. We investigated the relationships among the anatomical features of the aneurysm and A1 segment of the anterior cerebral artery (ACA), treatment procedures, and initial occlusion outcomes. We divided the initial microcatheter positions into greater and lesser curvatures based on the curvature from A1 to the aneurysm, and evaluated the outcomes. RESULTS: In total, 54 out of 66 patients (82%) achieved complete obliteration (CO) or had residual neck (RN) aneurysms, and 12 had residual aneurysms (RAs: 18%). Neck diameters and superior position aneurysms were correlated with initial occlusion outcomes in the multivariate analysis. The relationship between initial occlusion outcomes and initial microcatheter positions in superior position aneurysms (37 patients) was then examined. Eleven out of 26 patients (42.3%) had residual aneurysms at the greater curvature microcatheter position, whereas no residual aneurysms were detected at the lesser curvature microcatheter position. The A1 angle was not correlated with the outcomes. CONCLUSION: Wide-necked aneurysms and superior position aneurysms were identified as factors leading to incomplete occlusion in the endovascular treatment of anterior communicating artery aneurysms. The microcatheter position at the greater curvature in superior position aneurysms was a factor for incomplete occlusion. This suggests that guiding the microcatheter to the lesser curvature position of A1 is important in the treatment of superior position aneurysms.