{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T10:47:58Z","timestamp":1777718878815,"version":"3.51.4"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T00:00:00Z","timestamp":1716422400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background and objective<\/jats:title><jats:p>Current data on the optimal treatment modality for ruptured anterior communicating artery (AComA) aneurysms are limited. We conducted this multicenter retrospective study to evaluate the safety and clinical outcomes of endovascular treatment (EVT) and microsurgical clipping (MC) for the treatment of ruptured AComA patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with ruptured AComA aneurysms were screened from the Chinese Multicenter Cerebral Aneurysm Database. Propensity score matching (PSM) was used to adjust for baseline characteristic imbalances between the EVT and MC groups. The safety outcomes included total procedural complications, procedure-related morbidity\/death and remedial procedure for complication. The primary clinical outcome was 2-year functional independence measured by the modified Rankin scale (mRS) score.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The analysis included 893 patients with ruptured AComA aneurysms (EVT: 549; MC: 346). PSM yielded 275 pairs of patients in the EVT and MC cohorts for comparison. Decompressive craniectomy being more prevalent in the MC group (19.3% vs. 1.5%, <jats:italic>p\u2009&amp;lt;<\/jats:italic> 0.001). Safety data revealed a lower rate of total procedural complications (odds ratio [OR]\u2009=\u20090.62, 95% CI 0.39\u20130.99; <jats:italic>p\u2009=<\/jats:italic> 0.044) in the EVT group and similar rates of procedure-related morbidity\/death (OR\u2009=\u20090.91, 95% CI 0.48\u20131.73; <jats:italic>p\u2009=<\/jats:italic> 0.880) and remedial procedure for complication (OR\u2009=\u20091.35, 95% CI 0.51\u20133.69, <jats:italic>p\u2009=<\/jats:italic> 0.657) between the groups. Compared with that of MC patients, EVT patients had a greater likelihood of functional independence (mRS score 0\u20132) at discharge (OR\u2009=\u20091.68, 95% CI 1.14\u20132.50; <jats:italic>p\u2009=<\/jats:italic> 0.008) and at 2\u2009years (OR\u2009=\u20091.89, 95% CI 1.20\u20133.00; <jats:italic>p\u2009=<\/jats:italic> 0.005), a lower incidence of 2-year all-cause mortality (OR\u2009=\u20090.54, 95% CI 0.31\u20130.93; <jats:italic>p\u2009=<\/jats:italic> 0.023) and a similar rate of retreatment (OR\u2009=\u20091.00, 95% CI 0.23\u20134.40; <jats:italic>p\u2009=<\/jats:italic> 1.000).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Clinical outcomes after treatment for ruptured AComA aneurysms appear to be superior to those after treatment with MC, with fewer overall procedure-related complications and no increase in the retreatment rate. Additional studies in other countries are needed to verify these findings.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2024.1389950","type":"journal-article","created":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T05:15:12Z","timestamp":1716441312000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["The safety and clinical outcomes of endovascular treatment versus microsurgical clipping of ruptured anterior communicating artery aneurysms: a 2-year follow-up, multicenter, observational study"],"prefix":"10.3389","volume":"15","author":[{"given":"Minghao","family":"Yang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yang","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jia","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiuhu","family":"An","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongwen","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bangyue","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaowei","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Changkai","family":"Hou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linchun","family":"Huan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinyu","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianjun","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,5,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"18","DOI":"10.3171\/jns.1990.73.1.0018","article-title":"The international cooperative study on the timing of aneurysm surgery. Part 1: overall management results","volume":"73","author":"Kassell","year":"1990","journal-title":"J Neurosurg"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1267","DOI":"10.1016\/s0140-6736(02)11314-6","article-title":"International subarachnoid aneurysm trial (Isat) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial","volume":"360","author":"Molyneux","year":"2002","journal-title":"Lancet"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1093\/neuros\/nyw051","article-title":"Changing paradigms in the endovascular management of ruptured anterior communicating artery aneurysms","volume":"81","author":"Moon","year":"2017","journal-title":"Neurosurgery"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e30754","DOI":"10.1097\/md.0000000000030754","article-title":"Outcome of ruptured anterior communicating artery aneurysm treatment compared between surgical clipping and endovascular coiling: a single-center analysis","volume":"101","author":"Lee","year":"2022","journal-title":"Medicine"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1227\/neu.0000000000000878","article-title":"Treatment of ruptured anterior communicating artery aneurysms: equipoise in the endovascular era?","volume":"77","author":"Moon","year":"2015","journal-title":"Neurosurgery"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.wneu.2023.03.111","article-title":"Surgery or endovascular treatment in patients with anterior communicating artery aneurysm: a systematic review and Meta-analysis","volume":"175","author":"Sattari","year":"2023","journal-title":"World Neurosurg"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The strengthening the reporting of observational studies in epidemiology (Strobe) statement: guidelines for reporting observational studies","volume":"61","author":"von Elm","year":"2008","journal-title":"J Clin Epidemiol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1016\/0895-4356(94)90129-5","article-title":"Validation of a combined comorbidity index","volume":"47","author":"Charlson","year":"1994","journal-title":"J Clin Epidemiol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1097\/sla.0000000000001797","article-title":"Potential pitfalls of reporting and Bias in observational studies with propensity score analysis assessing a surgical procedure: a methodological systematic review","volume":"265","author":"Lonjon","year":"2017","journal-title":"Ann Surg"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"734","DOI":"10.1002\/sim.2580","article-title":"A comparison of the ability of different propensity score models to balance measured variables between treated and untreated subjects: a Monte Carlo study","volume":"26","author":"Austin","year":"2007","journal-title":"Stat Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1016\/j.jacc.2016.10.060","article-title":"Comparison of propensity score methods and covariate adjustment: evaluation in 4 cardiovascular studies","volume":"69","author":"Elze","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"268","DOI":"10.7326\/m16-2607","article-title":"Sensitivity analysis in observational research: introducing the E-value","volume":"167","author":"VanderWeele","year":"2017","journal-title":"Ann Intern Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1080\/02688697.2020.1812517","article-title":"Comparison between outcomes of endovascular and surgical treatments of ruptured anterior communicating artery aneurysms","volume":"35","author":"Harris","year":"2021","journal-title":"Br J Neurosurg"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"2119","DOI":"10.3174\/ajnr.A5355","article-title":"Patient outcomes and cerebral infarction after ruptured anterior communicating artery aneurysm treatment","volume":"38","author":"Heit","year":"2017","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"3","DOI":"10.3171\/jns.2003.99.1.0003","article-title":"Treatment of anterior communicating artery aneurysms: complementary aspects of microsurgical and endovascular procedures","volume":"99","author":"Proust","year":"2003","journal-title":"J Neurosurg"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1007\/s10143-017-0932-y","article-title":"\"Coil mainly\" policy in Management of Intracranial Acoa Aneurysms: single-Centre experience with the systematic review of literature and meta-analysis","volume":"41","author":"Steklacova","year":"2018","journal-title":"Neurosurg Rev"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e1246","DOI":"10.1016\/j.wneu.2019.03.074","article-title":"Endovascular coiling versus surgical clipping of very small ruptured anterior communicating artery aneurysms","volume":"126","author":"Zhao","year":"2019","journal-title":"World Neurosurg"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1018","DOI":"10.1136\/neurintsurg-2021-017695","article-title":"Endovascular treatment of ruptured anterior communicating aneurysms: a 17-year institutional experience with coil embolization","volume":"14","author":"Catapano","year":"2022","journal-title":"J Neurointerv Surg"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"2776","DOI":"10.1161\/strokeaha.107.505222","article-title":"Impact of anatomic features in the endovascular embolization of 181 anterior communicating artery aneurysms","volume":"39","author":"Gonzalez","year":"2008","journal-title":"Stroke"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1136\/neurintsurg-2018-013943","article-title":"Stent-assisted coil embolization of anterior communicating artery aneurysms: safety, effectiveness, and risk factors for procedural complications or recanalization","volume":"11","author":"Choi","year":"2019","journal-title":"J Neurointerv Surg"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1016\/j.clineuro.2016.03.020","article-title":"Stent-assisted coiling versus coiling alone of ruptured anterior communicating artery aneurysms: a single-center experience","volume":"144","author":"Fan","year":"2016","journal-title":"Clin Neurol Neurosurg"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1502","DOI":"10.3174\/ajnr.A1618","article-title":"Stent-assisted embolization of wide-neck anterior communicating artery aneurysms: review of 21 consecutive cases","volume":"30","author":"Huang","year":"2009","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1016\/j.pjnns.2016.07.008","article-title":"Stent-assisted embolization of wide-neck anterior communicating artery aneurysms: review of consecutive 34 cases","volume":"50","author":"Kocur","year":"2016","journal-title":"Neurol Neurochir Pol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1101859","DOI":"10.3389\/fneur.2023.1101859","article-title":"Comparison of staged-stent and stent-assisted coiling technique for ruptured saccular wide-necked intracranial aneurysms: safety and efficacy based on a propensity score-matched cohort study","volume":"14","author":"Zhang","year":"2023","journal-title":"Front Neurol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"106252","DOI":"10.1016\/j.clineuro.2020.106252","article-title":"Decompressive craniectomy in aneurysmal subarachnoid hemorrhage: who and when? \u2013 a systematic review and meta-analysis","volume":"199","author":"Darkwah Oppong","year":"2020","journal-title":"Clin Neurol Neurosurg"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"E4","DOI":"10.3171\/2009.3.Focus0954","article-title":"Decompressive craniectomy in subarachnoid hemorrhage","volume":"26","author":"G\u00fcresir","year":"2009","journal-title":"Neurosurg Focus"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1016\/j.wneu.2016.12.012","article-title":"Time is brain! analysis of 245 cases with decompressive craniectomy due to subarachnoid hemorrhage","volume":"98","author":"Jabbarli","year":"2017","journal-title":"World Neurosurg"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"349","DOI":"10.31083\/j.jin.2020.02.125","article-title":"Anterior communicating artery aneurysm rupture and functional outcome in short-term: clipping versus coiling","volume":"19","author":"B\u00e4cker","year":"2020","journal-title":"J Integr Neurosci"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"943","DOI":"10.3174\/ajnr.A3802","article-title":"Endovascular treatment of anterior communicating artery aneurysms: a systematic review and meta-analysis","volume":"35","author":"Fang","year":"2014","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"3157","DOI":"10.1007\/s10143-022-01853-w","article-title":"Intra-procedural complications, success rate, and need for retreatment of endovascular treatments in anterior communicating artery aneurysms: a systematic review and meta-analysis","volume":"45","author":"Yarahmadi","year":"2022","journal-title":"Neurosurg Rev"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"87","DOI":"10.3171\/2021.7.Jns211323","article-title":"Endovascular therapy versus microsurgical clipping of ruptured wide neck aneurysms (Everrun registry): a multicenter, prospective propensity score analysis","volume":"137","author":"Mascitelli","year":"2021","journal-title":"J Neurosurg"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"621","DOI":"10.3171\/2014.11.Jns141607","article-title":"Operative complications and differences in outcome after clipping and coiling of ruptured intracranial aneurysms","volume":"123","author":"Ayling","year":"2015","journal-title":"J Neurosurg"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1016\/s0140-6736(14)60975-2","article-title":"The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the international subarachnoid aneurysm trial (Isat)","volume":"385","author":"Molyneux","year":"2015","journal-title":"Lancet"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"3093","DOI":"10.1161\/strokeaha.111.619510","article-title":"Higher incidence of in-hospital complications in patients with clipped versus coiled ruptured intracranial aneurysms","volume":"42","author":"Vergouwen","year":"2011","journal-title":"Stroke"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1186\/s12883-020-01871-5","article-title":"Recurrence and retreatment of anterior communicating artery aneurysms after endovascular treatment: a retrospective study","volume":"20","author":"Jang","year":"2020","journal-title":"BMC Neurol"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2024.1389950\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T05:15:14Z","timestamp":1716441314000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2024.1389950\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,23]]},"references-count":35,"alternative-id":["10.3389\/fneur.2024.1389950"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2024.1389950","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,23]]},"article-number":"1389950"}}