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
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