Key result
In patients with aneurysmal subarachnoid hemorrhage, very small anterior communicating artery aneurysms (<5 mm) were not associated with a higher risk of new focal neurological deficits compared to larger aneurysms, though they exhibited a higher in-hospital rebleeding rate (2.8% vs 2.1%).
Why the study?
Single-center studies report that very small anterior communicating artery aneurysms harbor particular treatment risks in patients with aneurysmal subarachnoid hemorrhage.
Do very small anterior communicating artery aneurysms increase the risk of poor clinical and radiological outcomes in patients with aneurysmal subarachnoid hemorrhage compared to other aneurysm sizes and locations?
Cohort (n=1,258)
Yes
Do very small anterior communicating artery aneurysms increase the risk of poor clinical and radiological outcomes in patients with aneurysmal subarachnoid hemorrhage compared to other aneurysm sizes and locations?
Absolute Event Rate: 13% vs 19%
Very small ruptured anterior communicating artery aneurysms have a higher in-hospital rebleeding rate but are not associated with worse morbidity or mortality compared to larger or differently located aneurysms.
vsACoA rebleeding risk may prompt closer surveillance; leaves open whether size or location drives aSAH outcomes.
BACKGROUND: Very small anterior communicating artery aneurysms (vsACoA) of <5 mm in size are detected in a considerable number of patients with aneurysmal subarachnoid hemorrhage (aSAH). Single-center studies report that vsACoA harbor particular risks when treated. OBJECTIVE: To assess the clinical and radiological outcome(s) of patients with aSAH diagnosed with vsACoA after aneurysm treatment and at discharge. METHODS: Information on n = 1868 patients was collected in the Swiss Subarachnoid Hemorrhage Outcome Study registry between 2009 and 2014. The presence of a new focal neurological deficit at discharge, functional status (modified Rankin scale), mortality rates, and procedural complications (in-hospital rebleeding and presence of a new stroke on computed tomography) was assessed for vsACoA and compared with the results observed for aneurysms in other locations and with diameters of 5 to 25 mm. RESULTS: This study analyzed n = 1258 patients with aSAH, n = 439 of which had a documented ruptured ACoA. ACoA location was found in 38% (n = 144/384) of all very small ruptured aneurysms. A higher in-hospital bleeding rate was found in vsACoA compared with non-ACoA locations (2.8 vs 2.1%), especially when endovascularly treated (2.1% vs 0.5%). In multivariate analysis, aneurysm size of 5 to 25 mm, and not ACoA location, was an independent risk factor for a new focal neurological deficit and a higher modified Rankin scale at discharge. Neither very small aneurysm size nor ACoA location was associated with higher mortality rates at discharge or the occurrence of a peri-interventional stroke. CONCLUSION: Very small ruptured ACoA have a higher in-hospital rebleeding rate but are not associated with worse morbidity or mortality.
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Roethlisberger et al. (2022) conducted a cohort in Aneurysmal subarachnoid hemorrhage (aSAH) (n=1,258). Very small (<5 mm) anterior communicating artery aneurysm (vsACoA) vs. Aneurysms in other locations (non-ACoA) and with diameters of 5 to 25 mm was evaluated on New focal neurological deficit at discharge. In patients with aneurysmal subarachnoid hemorrhage, very small anterior communicating artery aneurysms (<5 mm) were not associated with a higher risk of new focal neurological deficits compared to larger aneurysms, though they exhibited a higher in-hospital rebleeding rate (2.8% vs 2.1%).
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