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AJNR - American Journal of Neuroradiology

Published ahead of print on November 16, 2007
doi: 10.3174/ajnr.A0806

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American Journal of Neuroradiology 29:286-290, February 2008
© 2008 American Society of Neuroradiology

INTERVENTIONAL

Clinical Outcome and Ischemic Complication after Treatment of Anterior Choroidal Artery Aneurysm: Comparison between Surgical Clipping and Endovascular Coiling

B.M. Kim^a, D.I. Kim^c, Y.S. Shin^d, E.C. Chung^a, D.J. Kim^c, S.H. Suh^c, S.Y. Kim^e, S.I. Park^f, C.S. Choi^b and Y.S. Won^b

^a Departments of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, South Korea
^b Departments of Neurosurgery, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, South Korea
^c Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea
^d Departments of Neurosurgery, Ajou University College of Medicine, Suwon, South Korea
^e Departments of Radiology, Ajou University College of Medicine, Suwon, South Korea
^f Department of Radiology, Soonchunhyang University, Bucheon Hospital, Bucheon, South Korea

Please address correspondence to Yong Sam Shin, Department of Neurosurgery, Ajou University College of Medicine, Suwon, South Korea, 442-721; e-mail: nsshin{at}ajou.ac.kr

BACKGROUND AND PURPOSE: Although coiling has been favorably comparable with clipping for treatment of most intracranial aneurysms, there is a controversy on which modality is safer for anterior choroidal artery (AchoA) aneurysm. We retrospectively evaluated the clinical outcomes and treatment-related complications after surgical clipping and endovascular coiling of AchoA aneurysms.

MATERIALS AND METHODS: Seventy-three AchoA aneurysms were recruited from 1895 intracranial aneurysms, which were treated either by surgical clipping or by endovascular coiling in 4 institutions between May 1999 and December 2006. The AchoA aneurysms were dichotomized according to the modality of treatment, the coil group (37 patients; 38 aneurysms) and the clip group (35 patients; 35 aneurysms). Clinical outcomes and incidence of treatment-related complications between 2 groups and the factors influencing the clinical outcomes were evaluated.

RESULTS: There was no rebleeding in both groups during follow-up, for 4–72 months (mean, 27 months) in the coil group and for 3–84 months (mean, 34 months) in the clip group. In the coil group, 31 patients (83.8%) had favorable outcome (modified Rankin Scale score [mRS], 0–3). In the clip group, 31 patients (88.6%) had favorable outcome. The complication of coiling was transient contralateral hemiparesis in 2 patients, who recovered completely. The complications of clipping were permanent contralateral hemiparesis due to AchoA infarction in 4 patients and third-nerve palsy in 1 patient. Hunt and Hess grade 4 or 5 and AchoA infarction were significantly correlated with poor outcome (mRS, 4). Clipping had significantly higher incidence of AchoA infarction than coiling (P < .05).

CONCLUSION: Coiling of AchoA aneurysms appears comparable with clipping in clinical outcome and prevention of rebleeding, with significantly lower incidence of AchoA infarction than clipping.