outcomes a nalysis of r uptured d istal a nterior Cerebral a rtery a neurysms treated by e ndosaccular e mbolization and Surgical Clipping

Summary Although endovascular surgery is now widely used to treat intracranial aneurysms, no compar-ative studies of clipping versus endovascular sur-gery to address distal ACA aneurysms at the same institution are available. We compared the results of these treatment modalities to address distal ACA aneurysms at our institution.We treated 68 patients with ruptured distal ACA aneurysms (endovascular surgery, n=13; clipping surgery, n=55). We performed a retro-spective comparison of the treatment outcomes. To study the efficacy of endovascular surgery we classified all our cases into three types: type A were small-necked aneurysms, type B were wide-necked aneurysms on the parent artery, and type C were aneurysms in which the A3 portion of the ACA arose from the aneurysmal dome near the neck. Intraoperative hemorrhage occurred in 7.7% of aneurysms treated by endovascular surgery and in 34.5% treated by clipping surgery. In 7.7% of the endovascularly-treated aneurysms we noted coil migration during embolization surgery; venous infarction due to cortical vein injury occurred in 7.3% of clipped aneurysms. Of the endovascularly-treated aneurysms, 7.7% manifested post-embolization hemorrhage; 23.1% manifested coil compaction. In clipping surgery, postoperative rerupture occurred in 1.8% of the aneurysms; one patient presented with postoperative acute epidural hematoma. Clip dislocation was noted in 1.8% of aneu-rysms. Angiography was indicative of post-treat-ment vasospasm in 7.7% of aneurysms treated endovascularly and in 50.9% of the clipped an-eurysms. The clinical outcome showed no significant difference between endovascular surgery and clipping surgery.