| Objective: To summarize the clinical data of ACo A aneurysm patients and explore the safety and effectiveness of treating intracranial ACo A aneurysm with endovascular embolization; analyze the related factors affecting the prognosis of patient and the recurrence of aneurysm; summarize the experience of treating intracranial anterior communicating aneurysm with endovascular embolization.Methods: A retrospective analysis on the clinical data of 189 cases of intracranial ACo A aneurysms receiving treatment of endovascular embolization at the neurosurgery department of the Yi Ji Shan Hospital affiliated to Wan Nan Medical College from Jan. 01, 2010 to May. 31, 2014, and angiographic follow-up was conducted for 3~24 months. Statistical analyses were performed on the gender, age of onset and gender distribution of patients, aneurysm-related data, preoperative state of patients, timing of interventional operation, methods of interventional treatment, extent of aneurysm embolization, intraoperative complications of intervention operation, whether recanalization existed during angiographic follow-ups, and GOS score at discharge and the last follow-up.Results: A total of 189 cases of intracranial anterior communicating aneurysm were included with 101 males and 88 females, and the male female ratio was 1.15:1 and the average age was(54.7±11.2) years; preoperative Hunt-Hess grade: there were 157 cases of Grade 0 ~Ⅲ, 32 cases of Grade Ⅳ~Ⅴ. There were 121 cases of microaneurysm, 67 cases of medium-sized aneurysm, 0 cases of large aneurysm and 1 cases of giant aneurysm; there were 150 cases of wide-necked aneurysm and 39 casesof narrow-necked aneurysm. There were 42 cases of saccular aneurysm, 36 cases of aneurysm with vesicles on the top, 38 cases of peanut-shaped aneurysm, 17 cases of lobulated aneurysm, 10 cases of cone aneurysm and 46 cases of irregularly shaped aneurysm. There were 189 cases of successful embolization of anterior communicating aneurysm, 161 cases of complete embolization, 16 cases of neck residual and 12 cases of subtotal occlusion;146 cases received simple coil embolization and 13 cases received treatment with dual catheter technique, and there were 125 cases of complete embolization, 14 cases of neck residual and 7 cases of subtotal occlusion; 43 cases received SAC embolization for wide-necked aneurysm and there were 36 cases of complete embolization, 2 cases of neck residual and 5 cases of subtotal occlusion; there were 184 cases of ruptured aneurysm, 5 cases of unruptured aneurysm, 147 cases received acute treatment for ruptured ACo A aneurysm and 37 cases received non-acute treatment for ruptured ACo A aneurysm. There were 12 cases of intraoperative concurrent cerebral vasospasm, 6 cases of thrombosis, 3 cases of intraoperative aneurysm rupture and 1 cases of death due to hemorrhage. Postoperative angiographic follow-up was performed in 92 cases for 3~24 months and no recurrent hemorrhage was observed; there were 14 relapsed cases, and relapse or recurrent hemorrhage was not observed in the 23 cases received stent-assisted treatment. The complete embolization rate of treating ACo A wide-necked aneurysm with SAC was higher than that in the CA group, and the differences of embolization degree between the two groups were not statistically significant. The complete embolization rate for narrow-necked ACo A aneurysm in the CA group was higher than that for wide-necked ACo A aneurysm, and were not statistically significant. The risk of intraoperative thrombosis of SAC is higher than that of CA and the difference is highly statistically significant. The comparison result of GOS scores at discharge in patients with Grade 0~III and Grade IV~V of preoperative Hunt-Hess grade was statistically significant. The incidence rate of intraoperative complications in SAC group was higher than that in the CA group, and the difference was statistically significant. The recurrence rate after treatment forwide-necked anterior communicating aneurysm in SAC group was lower than that in the CA group, and the difference was statistically significant.Conclusion: Treating ACo A aneurysm with endovascular embolization is safe and effective. The survival prognosis in patients with Hunt-Hess Grade 0 ~ III is significantly prior to the patients with Hunt-Hess Grade IV~V. The prognosis of patients with ruptured ACo A aneurysm is not directly correlated with the timing of surgery, and preoperative aneurysm rupture and recurrent hemorrhage are the leading causes of death and poor prognosis. Therefore, surgery for SSAH patients should be performed as soon as possible. SAC has a relatively higher rate of complete embolization and surgical risk compared with CA, and proper treatment for intraoperative complications can effectively improve the quality of care and reduce adverse prognosis. Applying SAC treatment for wide-necked ACo A aneurysm can significantly reduce the relapse rate. |
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