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  • Factors that Predict Poor Outcome after Treatment of Un-ruptured Anterior Communicating Artery Aneurysms

    Final Number:

    Govind M. Krishnan BA; Jonathan A. White MD

    Study Design:

    Subject Category:

    Meeting: AANS/CNS Cerebrovascular Section 2014 Annual Meeting

    Introduction: Management of unruptured anterior communicating artery (ACOM) aneurysms is variable. The objective of this study was to identify demographical information, presentation indices, and clinical information that could help predict patient outcome after undergoing treatment for an unruptured ACOM aneurysm.

    Methods: The study was a retrospective review of 139 patients with unruptured ACOM aneurysms, from 2007 to 2012, who underwent either microsurgical clipping or endovascular coiling to treat the aneurysm. Demographics, medical history, presenting clinical condition, and patient outcomes were analyzed. The outcome of the treatment was quantified using the Glasgow Outcome Score. A score of 3 or greater at discharge was considered a poor outcome whereas a score of less than 3 was considered a favorable outcome. Multivariate regression analysis was used to identify significant predictors of poor outcome.

    Results: A favorable outcome at discharge was achieved in 116 of the 139 total patients (83.45%). Multivariate analysis identified patient age greater than 70 (p < 0.005), history of prior brain injury or surgery (p < 0.005), current, but not previous, smoking (p < 0.05), aneurysms of size greater than 20mm (p < 0.05), duration of temporary occlusion greater than 20 mintues (p < 0.001), and the use of microsurgical clipping (p < 0.005), as significant predictors of poor outcome.

    Conclusions: Age over 70, prior history of brain injury, current smoking, and an aneurysm size greater than 20mm, 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 unruptured 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.

    Patient Care: This research will have a direct impact on patient care since it clearly delineates certain risk factors as more significant than others with regards to patient outcome. This study enables physicians to make informed decisions about whether or not they should undertake a procedure in a patient with an un-ruptured aneurysm. It highlights certain factors such as age or history of prior brain injury as significant in determining post-operative morbidity, and therefore physicians can now make even more informed decisions about whether or not to operate based on their patients' pre-operative condition.

    Learning Objectives: By the conclusion of this session, participants should be able to 1) gain an appreciation for the multitude of factors that can affect the outcome of a patient undergoing surgery for an un-ruptured aneurysm 2) understand that certain pre and peri-operative factors (those highlighted in the study) are better predictors of post-operative outcome than others

    References: 1. Awan LM, et al. Aneurysmal subarachnoid haemorrhage: outcome of aneurysm clipping in elderly patients and predictors of unfavourable outcome. Journal of College of Physicians and Surgeons Pakistan. 2013 May;23(5):334-7 2. Inamasu J, et al. Clinical characteristics and risk factors of chronic subdural hematoma associated with clipping of unruptured cerebral aneurysms. Journal of Clinical Neuroscience (2013), 3. Kerner A, et al. Impact of hyperglycemia on neurological deficits and extracellular glucose levels in aneurysmal subarachnoid hemorrhage patients. Journal of Neurology Research. 2007 Oct;29(7):647-53. 4. Krishnamurthy S, Kelleher JP, Lehman EB, Cockroft KM. Effects of tobacco dose and length of exposure on delayed neurological deterioration and overall clinical outcome after aneurysmal subarachnoid hemorrhage. Neurosurgery. 2007 Sep;61(3):475-80. 5. Martin GE, et al. Olfactory dysfunction after subarachnoid hemorrhage caused by ruptured aneurysms of the anterior communicating artery. Journal of Neurosurgery. 2009 Nov;111(5):958-62. 6. Matsukawa H, et al. Morphological and clinical risk factors for the rupture of anterior communicating artery aneurysms. Journal of Neurosurgery. 2013 May;118(5):978-83. 7. Mericle RA, Reig AS, Burry MV, Eskioglu E, Firment CS, Santra S. Endovascular Surgery for proximal posterior inferior cerebellar artery aneurysms: an analysis of Glasgow Outcome Score by Hunt-Hess grades. Neurosurgery. 2006 58(4):619-25 8. Naval NS, et al. Impact of pattern of admission on outcomes after aneurysmal subarachnoid hemorrhage. Journal of Critical Care. 2012 Oct;27(5):532.e1-7 9. Rosengart AJ, et al. Outcome in patients with subarachnoid hemorrhage treated with antiepileptic drugs. Journal of Neurosurgery. 2007 Aug;107(2):253-60. 10. Shirao S, et al. Age limit for surgical treatment of poor-grade patients with subarachnoid hemorrhage: A project of the Chugoku-Shikoku division of the Japan neurosurgical society. Surgical Neurology International. 2012;3:143. 11. Siddiq F, Chaudhry SA, Tummala RP, Suri MF, Qureshi AI. Factors and outcomes associated with early and delayed aneurysm treatment in subarachnoid hemorrhage patients in the United States. Neurosurgery. 2012 Sep;71(3):670-7

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