Acta Neurochir (Wien). 2025 Sep 1;167(1):235. doi: 10.1007/s00701-025-06647-9.
ABSTRACT
PURPOSE: Anterior choroidal artery (AChoA) aneurysms are rare and pose a significant treatment challenge due to the artery’s small caliber and critical vascular territory. Endovascular treatment (EVT) has become a preferred approach, but optimal management strategies remain debated. This study compares the efficacy and safety of different EVT techniques, including primary coiling, stent-assisted coiling (SAC), and flow diversion (FD), in treating AChoA aneurysms.
METHODS: Patients were categorized by endovascular technique, aneurysm morphology, and rupture status. Angiographic occlusion rates were assessed using the Raymond-Roy Occlusion Scale (RROS), and clinical outcomes were measured via the Modified Rankin Scale (mRS) at discharge and follow-ups. Statistical analyses compared occlusion rates, procedural complications, and functional outcomes among treatment groups.
RESULTS: In this study, 60 patients with 80 anterior choroidal artery aneurysms were treated. Among these, 44 aneurysms (55%) were classified as dependent, meaning the choroidal branch arose from the aneurysm dome or neck, while 36 aneurysms (45%) were independent, originating from the carotid artery near the choroidal branch. Primary coiling was used in 29 cases, stent-assisted coiling (SAC) in 21, and flow diversion (FD), with or without additional coiling, in 30 cases. Complete occlusion rates were significantly higher with SAC (83.3%) and FD (76.1%) compared to primary coiling (31.8%) (p < 0.05). Flow diversion was associated with more technical complications (25%), and ischemic events were more common in dependent aneurysms (p < 0.05). Importantly, no cases of symptomatic AChoA occlusion occurred after FD treatment. The overall mortality rate was 5%, with all deaths occurring in the primary coiling group among patients with ruptured aneurysms.
CONCLUSION: EVT of AChoA aneurysms is effective, with SAC and FD demonstrating superior occlusion rates compared to primary coiling. FD carries a higher risk of technical complications but maintains AChoA patency. To optimize outcomes, treatment choice should be guided by aneurysm morphology and patient risk factors.
PMID:40888948 | DOI:10.1007/s00701-025-06647-9
