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<!DOCTYPE html>
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<meta name="DC.Title" content="Endovascular Treatment of Anterior Communicating Artery Aneurysms: A Systematic Review and Meta-Analysis" />
<meta name="DC.Identifier" content="10.3174/ajnr.A3802" />
<meta name="DC.Date" content="2013-12-05" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Endovascular therapy has become an acceptable alternative to traditional clipping for the management of intracranial aneurysms. However, a limited number of studies have examined outcomes and complications specific to embolization of anterior communicating artery aneurysms.

MATERIALS AND METHODS: A systematic review of the literature was conducted with the use of multiple data bases to identify reports on endovascular treatment of anterior communicating artery aneurysms between 1994 and 2012. Angiographic results, clinical outcomes, and complication rates were pooled across studies by using random-effects meta-analysis with subgroup analysis of outcomes by rupture status and time trend stratification.

RESULTS: Fourteen studies, consisting of 1552 treated anterior communicating artery aneurysms, were included in this meta-analysis. The rate of immediate and long-term complete and near-complete angiographic occlusion was 88% (95% CI = 81–93%) and 85% (95% CI = 78–90%), respectively. Intraprocedural rupture rate was 4% (95% CI = 3–6%). The re-bleeding rate was 2% (95% CI = 1–4%) and the retreatment rate was 7% (95% CI = 5–12%). Morbidity or mortality caused by perioperative stroke occurred at a 3% (95% CI = 2–6%) rate. Overall procedure-related morbidity and mortality were 6% (95% CI = 4–8%) and 3% (95% CI = 2–4%), respectively. Outcomes did not differ between ruptured and unruptured aneurysms, nor did outcomes change over time, though these latter subanalyses were relatively underpowered.

CONCLUSIONS: Endovascular therapy for anterior communicating artery aneurysms is associated with a high rate of complete angiographic occlusion. However, the procedure-related permanent morbidity and mortality are not negligible for aneurysms in this location.

### Abbreviations

AcomA
:   anterior communicating artery
ISAT
:   International Subarachnoid Aneurysm Trial
CARAT
:   Cerebral Aneurysm Rerupture After Treatment" />
<meta name="DC.Contributor" content="S. Fang" />
<meta name="DC.Contributor" content="W. Brinjikji" />
<meta name="DC.Contributor" content="M.H. Murad" />
<meta name="DC.Contributor" content="D.F. Kallmes" />
<meta name="DC.Contributor" content="H.J. Cloft" />
<meta name="DC.Contributor" content="G. Lanzino" />
<meta name="article:published_time" content="2013-12-05" />
<meta name="article:section" content="INTERVENTIONAL" />
<meta name="citation_title" content="Endovascular Treatment of Anterior Communicating Artery Aneurysms: A Systematic Review and Meta-Analysis" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Endovascular therapy has become an acceptable alternative to traditional clipping for the management of intracranial aneurysms. However, a limited number of studies have examined outcomes and complications specific to embolization of anterior communicating artery aneurysms.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;A systematic review of the literature was conducted with the use of multiple data bases to identify reports on endovascular treatment of anterior communicating artery aneurysms between 1994 and 2012. Angiographic results, clinical outcomes, and complication rates were pooled across studies by using random-effects meta-analysis with subgroup analysis of outcomes by rupture status and time trend stratification.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Fourteen studies, consisting of 1552 treated anterior communicating artery aneurysms, were included in this meta-analysis. The rate of immediate and long-term complete and near-complete angiographic occlusion was 88% (95% CI = 81–93%) and 85% (95% CI = 78–90%), respectively. Intraprocedural rupture rate was 4% (95% CI = 3–6%). The re-bleeding rate was 2% (95% CI = 1–4%) and the retreatment rate was 7% (95% CI = 5–12%). Morbidity or mortality caused by perioperative stroke occurred at a 3% (95% CI = 2–6%) rate. Overall procedure-related morbidity and mortality were 6% (95% CI = 4–8%) and 3% (95% CI = 2–4%), respectively. Outcomes did not differ between ruptured and unruptured aneurysms, nor did outcomes change over time, though these latter subanalyses were relatively underpowered.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Endovascular therapy for anterior communicating artery aneurysms is associated with a high rate of complete angiographic occlusion. However, the procedure-related permanent morbidity and mortality are not negligible for aneurysms in this location.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_publication_date" content="2013/12/05" />
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<meta name="citation_author" content="S. Fang" />
<meta name="citation_author_institution" content="From Mayo Medical School (S.F.), Department of Radiology (W.B., D.F.K., H.J.C.), Division of Preventive Medicine (M.H.M.), and Department of Neurologic Surgery (G.L.), Mayo Clinic, Rochester, Minnesota." />
<meta name="citation_author" content="W. Brinjikji" />
<meta name="citation_author_institution" content="From Mayo Medical School (S.F.), Department of Radiology (W.B., D.F.K., H.J.C.), Division of Preventive Medicine (M.H.M.), and Department of Neurologic Surgery (G.L.), Mayo Clinic, Rochester, Minnesota." />
<meta name="citation_author" content="M.H. Murad" />
<meta name="citation_author_institution" content="From Mayo Medical School (S.F.), Department of Radiology (W.B., D.F.K., H.J.C.), Division of Preventive Medicine (M.H.M.), and Department of Neurologic Surgery (G.L.), Mayo Clinic, Rochester, Minnesota." />
<meta name="citation_author" content="D.F. Kallmes" />
<meta name="citation_author_institution" content="From Mayo Medical School (S.F.), Department of Radiology (W.B., D.F.K., H.J.C.), Division of Preventive Medicine (M.H.M.), and Department of Neurologic Surgery (G.L.), Mayo Clinic, Rochester, Minnesota." />
<meta name="citation_author" content="H.J. Cloft" />
<meta name="citation_author_institution" content="From Mayo Medical School (S.F.), Department of Radiology (W.B., D.F.K., H.J.C.), Division of Preventive Medicine (M.H.M.), and Department of Neurologic Surgery (G.L.), Mayo Clinic, Rochester, Minnesota." />
<meta name="citation_author" content="G. Lanzino" />
<meta name="citation_author_institution" content="From Mayo Medical School (S.F.), Department of Radiology (W.B., D.F.K., H.J.C.), Division of Preventive Medicine (M.H.M.), and Department of Neurologic Surgery (G.L.), Mayo Clinic, Rochester, Minnesota." />
<meta name="twitter:title" content="Endovascular Treatment of Anterior Communicating Artery Aneurysms: A Systematic Review and Meta-Analysis" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Endovascular therapy has become an acceptable alternative to traditional clipping for the management of intracranial aneurysms. However, a limited number of studies have examined outcomes and complications specific to embolization of anterior communicating artery aneurysms.

MATERIALS AND METHODS: A systematic review of the literature was conducted with the use of multiple data bases to identify reports on endovascular treatment of anterior communicating artery aneurysms between 1994 and 2012. Angiographic results, clinical outcomes, and complication rates were pooled across studies by using random-effects meta-analysis with subgroup analysis of outcomes by rupture status and time trend stratification.

RESULTS: Fourteen studies, consisting of 1552 treated anterior communicating artery aneurysms, were included in this meta-analysis. The rate of immediate and long-term complete and near-complete angiographic occlusion was 88% (95% CI = 81–93%) and 85% (95% CI = 78–90%), respectively. Intraprocedural rupture rate was 4% (95% CI = 3–6%). The re-bleeding rate was 2% (95% CI = 1–4%) and the retreatment rate was 7% (95% CI = 5–12%). Morbidity or mortality caused by perioperative stroke occurred at a 3% (95% CI = 2–6%) rate. Overall procedure-related morbidity and mortality were 6% (95% CI = 4–8%) and 3% (95% CI = 2–4%), respectively. Outcomes did not differ between ruptured and unruptured aneurysms, nor did outcomes change over time, though these latter subanalyses were relatively underpowered.

CONCLUSIONS: Endovascular therapy for anterior communicating artery aneurysms is associated with a high rate of complete angiographic occlusion. However, the procedure-related permanent morbidity and mortality are not negligible for aneurysms in this location.

### Abbreviations

AcomA
:   anterior communicating artery
ISAT
:   International Subarachnoid Aneurysm Trial
CARAT
:   Cerebral Aneurysm Rerupture After Treatment" />
<meta name="og-title" property="og:title" content="Endovascular Treatment of Anterior Communicating Artery Aneurysms: A Systematic Review and Meta-Analysis" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2013/12/05/ajnr.A3802" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Endovascular therapy has become an acceptable alternative to traditional clipping for the management of intracranial aneurysms. However, a limited number of studies have examined outcomes and complications specific to embolization of anterior communicating artery aneurysms.

MATERIALS AND METHODS: A systematic review of the literature was conducted with the use of multiple data bases to identify reports on endovascular treatment of anterior communicating artery aneurysms between 1994 and 2012. Angiographic results, clinical outcomes, and complication rates were pooled across studies by using random-effects meta-analysis with subgroup analysis of outcomes by rupture status and time trend stratification.

RESULTS: Fourteen studies, consisting of 1552 treated anterior communicating artery aneurysms, were included in this meta-analysis. The rate of immediate and long-term complete and near-complete angiographic occlusion was 88% (95% CI = 81–93%) and 85% (95% CI = 78–90%), respectively. Intraprocedural rupture rate was 4% (95% CI = 3–6%). The re-bleeding rate was 2% (95% CI = 1–4%) and the retreatment rate was 7% (95% CI = 5–12%). Morbidity or mortality caused by perioperative stroke occurred at a 3% (95% CI = 2–6%) rate. Overall procedure-related morbidity and mortality were 6% (95% CI = 4–8%) and 3% (95% CI = 2–4%), respectively. Outcomes did not differ between ruptured and unruptured aneurysms, nor did outcomes change over time, though these latter subanalyses were relatively underpowered.

CONCLUSIONS: Endovascular therapy for anterior communicating artery aneurysms is associated with a high rate of complete angiographic occlusion. However, the procedure-related permanent morbidity and mortality are not negligible for aneurysms in this location.

### Abbreviations

AcomA
:   anterior communicating artery
ISAT
:   International Subarachnoid Aneurysm Trial
CARAT
:   Cerebral Aneurysm Rerupture After Treatment" />
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      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">INTERVENTIONAL</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Endovascular Treatment of Anterior Communicating Artery Aneurysms: A Systematic Review and Meta-Analysis</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">S. Fang</span>, <span class="highwire-citation-author" data-delta="1">W. Brinjikji</span>, <span class="highwire-citation-author" data-delta="2">M.H. Murad</span>, <span class="highwire-citation-author" data-delta="3">D.F. Kallmes</span>, <span class="highwire-citation-author" data-delta="4">H.J. Cloft</span> and <span class="highwire-citation-author" data-delta="5">G. Lanzino</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">December 2013,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A3802 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-51083--61438137736" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">S. Fang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From Mayo Medical School (S.F.), Department of Radiology (W.B., D.F.K., H.J.C.), Division of Preventive Medicine (M.H.M.), and Department of Neurologic Surgery (G.L.), Mayo Clinic, Rochester, Minnesota.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BFang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Fang%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AS.%2BFang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">W. Brinjikji </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From Mayo Medical School (S.F.), Department of Radiology (W.B., D.F.K., H.J.C.), Division of Preventive Medicine (M.H.M.), and Department of Neurologic Surgery (G.L.), Mayo Clinic, Rochester, Minnesota.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=W.%2BBrinjikji%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Brinjikji%20W&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AW.%2BBrinjikji%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">M.H. Murad </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From Mayo Medical School (S.F.), Department of Radiology (W.B., D.F.K., H.J.C.), Division of Preventive Medicine (M.H.M.), and Department of Neurologic Surgery (G.L.), Mayo Clinic, Rochester, Minnesota.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.H.%2BMurad%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Murad%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AM.H.%2BMurad%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">D.F. Kallmes </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From Mayo Medical School (S.F.), Department of Radiology (W.B., D.F.K., H.J.C.), Division of Preventive Medicine (M.H.M.), and Department of Neurologic Surgery (G.L.), Mayo Clinic, Rochester, Minnesota.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.F.%2BKallmes%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kallmes%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AD.F.%2BKallmes%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">H.J. Cloft </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From Mayo Medical School (S.F.), Department of Radiology (W.B., D.F.K., H.J.C.), Division of Preventive Medicine (M.H.M.), and Department of Neurologic Surgery (G.L.), Mayo Clinic, Rochester, Minnesota.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=H.J.%2BCloft%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Cloft%20H&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AH.J.%2BCloft%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">G. Lanzino </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From Mayo Medical School (S.F.), Department of Radiology (W.B., D.F.K., H.J.C.), Division of Preventive Medicine (M.H.M.), and Department of Neurologic Surgery (G.L.), Mayo Clinic, Rochester, Minnesota.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.%2BLanzino%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lanzino%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AG.%2BLanzino%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Fang</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">W.</span> <span class="nlm-surname">Brinjikji</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">M.H.</span> <span class="nlm-surname">Murad</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">D.F.</span> <span class="nlm-surname">Kallmes</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">H.J.</span> <span class="nlm-surname">Cloft</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Lanzino</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Dec 2013, </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3802 </span></div>
  
  
  
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      <div class="highwire-cite-title">Endovascular Treatment of Anterior Communicating Artery Aneurysms: A Systematic Review and Meta-Analysis</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Fang</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">W.</span> <span class="nlm-surname">Brinjikji</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">M.H.</span> <span class="nlm-surname">Murad</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">D.F.</span> <span class="nlm-surname">Kallmes</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">H.J.</span> <span class="nlm-surname">Cloft</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Lanzino</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Dec 2013, </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3802 </span></div>
  
  
  
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