Factors that Predict Poor Outcome after Treatment of Un-Ruptured Anterior Communicating Artery Aneurysms
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INTRODUCTION: Management of un-ruptured anterior communicating artery (ACOM) aneurysm is variable. The objective of this study was to identify demographic information, presentation indices, and clinical information that could help predict pattern outcomes after undergoing treatment for an un-ruptured ACOM aneurysm. METHODS: The study was a retrospective review of 139 patients with un-ruptured ACOM aneurysms from 2007 to 2012, who underwent either microsurgical clipping or endovascular coiling to treat the aneurysm. Demographics, medical history, presenting condition and patient outcomes were analyzed. The outcome of the treatment was quantified using the Glasgow Outcomes Score. A score of 3 or greater at discharge was considered favorable. Multivariate regression analysis was used to identify significant predictors of poor outcomes. RESULTS: A favorable outcome at discharge was achieved in 116 of the 139 total patients (83.45%). Multivariate analysis identified patient age grated than 70 (p<0.005), history of prior brain injury or surgery (p<0.005), current but not precious smoking (p<0.05), aneurysms of size greater than 20 mm (p<0.05), duration of temporary occlusions greater than 20 minutes (p<0.001), and the use of microsurgical clipping (p<0.005) as significant predictors of poor outcome. CONCLUSION: Age over 70, prior history of brain injury, current smoking, and an aneurysm size greater than 20 mm, along with the use of clipping and a duration of temporary occlusion greater than 20 minutes are the strongest predictors of poor outcome from treatment of un-ruptured ACOM aneurysms. This would indicate that treatment should be reconsidered in patients with any of the above risk factors and coiling should be attempted whenever possible.