Clinical Analysis Of Intravascular Therapy Of Anterior Communicating Aneurysm

Objective:To study the morphological characteristics of anterior communication complex and aneurysm of patients with anterior communicating aneurysms,and the strategies and methods of intravascular therapy,and to analyze their efficacy,safety and prognosis,so as to provide clinical experience and reference for the intravascular therapy of anterior communicating aneurysms.Methods:A total of 72 patients with anterior communicating artery aneurysms undergoing intravascular therapy who met the inclusion and exclusion criteria from July 1,2013 to December 31,2019 were collected from the Department of Cerebrovascular Diseases and Neurosurgery,the Second Affiliated Hospital of Kunming Medical University.Retrospective analysis of clinical data.All patients were evaluated for general condition after admission,GCS score and Hunt-Hess classification to assess the severity of the disease.All patients completed the head CT,CTA or MRA of the head and carotid arteries and DSA to confirm the diagnosis of subarachnoid hemorrhage and anterior communicating aneurysm,and intravascular therapy.To study the morphological characteristics(including the anterior cerebral artery A1 segment predominance,anterior communication artery variation,aneurysm size and direction of aneurysm)of the anterior communication complex and aneurysm of the patients through DSA and to adopt individualized intravascular therapy strategies and methods.According to the clinical symptoms,relevant inspections and blood lab reports assess postoperative complications.The Raymond rating evaluates the degree of immediate embolism of an aneurysm.The MRS score scale was followed up 6 months after surgery to evaluate the prognosis of patients.Results:1.General evaluation of 72 patients with anterior communicating aneurysm:42 males and 30 females.The age is 23-85 years old,the average is(55.7±1.2)years old.There were 24 cases of smoking history,43 cases of hypertension,9 cases of diabetes,and 5 cases of previous stroke.There were 62 ruptured aneurysms and 10 unruptured aneurysms.Hunt-Hess grade of ruptured aneurysms:5 cases with ? grade,39 cases with ? grade,16 cases with ? grade,and 2 cases with ? grade.Morphological evaluation of anterior communicating artery complex and aneurysm:72 patients with anterior communicating artery aneurysm were included.46 patients(63.9%)had an anterior cerebral artery A1 segment dominant sign,and 26 patients had anterior cerebral artery A1 segment average.3 patients found anterior communicating artery variation:2 cases of "3 A2 segments" type and 1 case of"fenestration" type.The anterior communicating aneurysm size was<3mm in 17 cases,3?5mm in 20 cases,5?10mm in 29 cases,and 10?25mm in 6 cases.Direction of aneurysm were pointed:27 cases were anterior-superior types,22 cases were anterior-inferior types,7 cases were direct-anterior types,2 cases were direct-inferior types,2 cases were posterior-superior type,5 cases were posterior-inferior types,and 7 cases were complex types.3.intravascular therapy methods and evaluation of efficacy and safety:58 of 72 patients were treated with simple coil embolization,and 14 were assisted with stent-assisted embolization(including 7 LVIS,2 LVIS Jr,2 LEO,1 LEO baby,1 Enterprise and 1 Solitaire).(1)The degree of embolization immediately after surgery:Raymond ? grade in 62 patients,grade ? in 8 patients,grade ? in 2 cases.,of which 14 patients of stent-assisted embolization were all grade ?.(2)Evaluation of complications:A total of 22 patients(30.6%)had complications after surgery.Ischemic events,psychiatric symptoms,cerebral vasospasm and electrolyte disorders are the most common complications.Of the 14 patients with stent-assisted embolization,6(42.9%)had complications,and 16(27.6%)had complications in 58 patients with simple embolization..The proportion of stent-assisted embolization in patients with intraoperative thrombosis(35.7%)and postoperative cerebral infarction(21.4%)was higher than those with simple embolization(5.2%and 15.5%,respectively).4.Follow-up results:Follow-up 6 months after the surgery,72 patients:52 patients were admitted to the hospital for review,and were examined by imaging(CTA/MRA/DSA),12 patients were followed up by telephone,and 8 patients were lost to follow-up.Three patients found a recurrence of the aneurysm neck(simple embolization group),re-intravascular therapy,and stent-assisted re-embolization with Raymond grade I.MRS score 6 months after surgery:51 patients(82.3%)had MRS scores of 0-2 points,and 11 patients(17.7%)had 3-5 points.2 deaths(3.1%).Most patients have a good prognosis after surgery.Conclusion:1.The morphological characteristics of the anterior communicating artery complex and anterior communicating artery aneurysm is an important basis for selecting Intravascular therapy strategies and methods.The anterior communicating aneurysm of the "anterior type" has a smaller shaping angle than the "posterior type"and "direct-inferior type" microcatheter heads and is easier to embolize.2.The protection of perforating branch of the anterior communicating artery complex during operation,timely detection,treatment of intraoperative thrombosis,vasospasm,etc.are important measures to reduce ischemic complications.3.Intravascular therapy of anterior communicating aneurysms is a safe and effective method.