RESUMEN
Objective: To identify whether intracranial hematoma (ICH) evacuation improves the prognosis of patients with ruptured anterior communicating artery (AcomA) aneurysms concomitant with small ICHs (≥10 mL and <25 mL). Methods: Data on patients diagnosed with small ICHs secondary to ruptured AcomA aneurysms who underwent surgery in our department between January 2010 and February 2018 was retrospectively analyzed. The patients were divided into two groups based on whether the hematoma was evacuated. The modified Rankin Scale (mRS) was used to assess prognosis six months after onset. Results: The study recruited 58 patients, 19 of whom underwent aneurysm clipping and ICH evacuation. While 33 patients underwent aneurysm clipping, 6 patients underwent coiling embolism without ICH evacuation. The average ICH volume was 15.27±4.07 mL. In the hematoma-evacuated group, 13 (68.4%) patients had unfavorable outcomes (mRS scores of 4 to 6). In the non-evacuated hematoma group, 13 (33.3%) patients had unfavorable outcomes (P = 0.001), postoperative infarction occurred in 11 (57.9%) patients in the hematoma evacuation group and 9 (23.1%) patients in the other group (P = 0.009). Conclusion: ICH evacuation was associated with unfavorable outcomes and postoperative infarction in ruptured AcomA aneurysms with concomitant small hematomas (<25 mL). Aneurysm clipping or coiling without ICH evacuation may be a safe and effective choice; however, further investigation is needed.
RESUMEN
BACKGROUND: Posterior communicating artery (PcomA) aneurysms are more likely to recanalize than anterior communicating artery (AcomA) aneurysms. However, it is still unclear whether the recanalization rate of these aneurysms is a result of involvement from the fetal posterior cerebral artery (fPCA) in PcomA aneurysms and variation of the unilateral A1 segment in AcomA aneurysms. The purpose of this study is to retrospectively evaluate the different recanalization rates between PcomA aneurysms with fPCA and AcomA aneurysms with a variation of the unilateral A1 segment. METHODS: We retrospectively collected information regarding 214 patients, each with communicating segment aneurysms between January 2013 and January 2020. Follow-up documentation on clinical and imaging data was comparatively analyzed between variant types, and recanalization rates of the variant and normal types were analyzed by stratification. RESULTS: Of the 84 variant-type aneurysms (PcomA with fPCA and AcomA with a variation of the unilateral A1 segment, 41/43), complete recanalization occurred in 23 patients (27.4%), and it was significantly more likely to occur in PcomA aneurysms with fPCA (39.1%) than in AcomA aneurysms with a variation of the unilateral A1 segment (16.3%). Stent-assisted coil embolization (SACE) has been shown to reduce recanalization (OR =0.092, 95% CI: 0.011 to 0.790, P=0.03). Additionally, variant types and the normal type (non-fetal, 106, and bilateral A1 symmetry, 24) have different odds ratios (OR) of recanalization (P=0.04), and the OR of the variant subtypes was significant, unlike the normal type (P=0.49). CONCLUSIONS: This study suggests that PcomA aneurysms with fPCA are more likely to recanalize than AcomA aneurysms with a variation of the unilateral A1 segment.
