Safety and Efficacy of Flow Diverters for Treatment of Unruptured Anterior Communicating Artery Aneurysms: Retrospective Multicenter Study.

Background: The anterior communicating artery (AComm) region is the most common site of intracranial aneurysms, with increased rupture risk compared with other locations. Overall, flow diverters present as a safe and efficacious treatment for intracranial aneurysms, but there is paucity of data for their use in the treatment of unruptured AComm aneurysms. We present the largest multicentric analysis evaluating the outcomes of flow diverters in AComm aneurysm treatment.
Methods: Databases from 10 centers were retrospectively reviewed for unruptured AComm aneurysms treated with flow diverters. Demographics, clinical presentation, radiographic characteristics, procedural complications, and outcomes were assessed.
Results: A total of 144 patients harboring 147 AComm aneurysms were treated between January 2012 and December 2021. Seventy-four were women (51.4%) and median age was 60 (IQR 50-67) years. All were unruptured AComm aneurysms. Half of the cohort had similar anterior cerebral artery sizes (51.4%). The most common morphology was saccular (94.6%), with a branch involvement in 32.7% of cases. Median vessel diameter was 2.4 mm, and the Pipeline Flex was the most prevalent device (32.7%). Median follow-up time was 17 months, with complete occlusion in 86.4% at the last follow-up. Functional independence (modified Rankin Scale score 0-2) was reported in 95.1%. Intraprocedural complications occurred in 5.6%, and postoperative complications were noted in 9.7% of cases. Combined major complication and mortality rate was 2.1%.
Conclusions: Our study suggests that flow diverters are a useful treatment for AComm aneurysms. Mid-term results indicated favorable aneurysm occlusion with a good safety profile. Additional prospective studies with longer follow-up periods and independent adjudication are warranted to better assess these results.
Competing Interests: Competing interests: IS is a consultant for Medtronic and Microvention. HSC is a stockholder from Neuravention, Vesalio, Syncron Tech, Bend It Tech, and Sim&Size, and is a consultant for Medtronic and Microvention. NK is a consultant and proctoring for Microvention. CI is a speaker for Microvention, holds patent from 4D G1 coil, and is a stockholder of Neuravention and Bend It. GD has consulting agreements with Microvention, Medtronic, Cerenovus, Stryker, Penumbra, and InNeuroCo. RAH is a consultant for Medtronic, Stryker, Cerenovous, Microvention, Balt, Phenox, Rapid Medical, and Q'Apel, is on the advisory board for MiVI, eLum, Three Rivers, Shape Medical, and Corindus, has unrestricted research grants from NIH, Interline Endowment, Microvention, Stryker, and CNX, and is an investor/stockholder for InNeuroCo, Cerebrotech, eLum, Endostream, Three Rivers Medical, Scientia, RisT, BlinkTBI, and Corindus. VMP serves as a consultant/steering committee member for Stryker, Penumbra, and Balt, a consultant for Medtronic and Neurovasc, and receives a research grant from Philips. DKL reports conflicts of interest with Medtronic and Stryker, being the national PI of the ADVANCE trial, receiving research grants, and being part of their advisory board.
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