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Background <p>Anatomical variants of the anterior cerebral artery (ACA) may increase technical complexity during endovascular treatment of distal ACA aneurysms (DACA). However, their impact on treatment outcomes remains unclear. This study evaluated whether ACA variants influence angiographic and clinical outcomes following endovascular treatment.</p> Methods <p>A retrospective multicenter analysis was conducted using data from the CRETA Registry, including patients with ruptured and unruptured DACA treated endovascularly. Patients were grouped according to ACA anatomy (variant vs. conventional). Outcomes were compared after propensity score matching (PSM) to adjust for confounders including age, aneurysm rupture status, dome-to-neck ratio, branch origin, and treatment type. The primary outcome was aneurysm occlusion at last follow-up based on the Raymond–Roy classification. Secondary outcomes included ischemic and hemorrhagic complications, vasospasm, and clinical outcome measured by the modified Rankin Scale (mRS).</p> Results <p>After PSM, 128 patients were included (64 per group). Among patients with available imaging follow-up (54 in the conventional group and 55 in the variant group), adequate occlusion rates were comparable between the variant and conventional ACA groups (81.5% vs. 85.5%; <i>p</i> = 0.600). No significant differences were observed in ischemic or hemorrhagic complications, vasospasm, or long-term clinical outcomes. Sensitivity analyses confirmed the robustness of the findings.</p> Conclusions <p>ACA anatomical variants do not adversely affect the safety or efficacy of endovascular treatment for DACA. With appropriate anatomical assessment and treatment selection, endovascular therapy remains effective even in the presence of complex ACA configurations.</p>

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Anterior cerebral artery variants and their influence on endovascular outcomes: a propensity score matched analysis from the CRETA registry

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月6日

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  • Arturo Consoli,
  • Raffaele Tortora,
  • Frédéric Clarençon,
  • Adam A. Dmytriw,
  • Eimad Shotar,
  • Pascal Jabbour,
  • Marios Psychogios,
  • Peter Sporns,
  • Ajit S. Puri,
  • Ameer E Hassan,
  • Oktay Algin,
  • Markus A. Möhlenbruch,
  • Riccardo Russo,
  • Oded Goren,
  • Gregoire Boulouis,
  • Takeshi Morimoto,
  • Raoul Pop,
  • Joanna WK Ho,
  • Virginia Pujol Lereis,
  • Jared Cooper,
  • Giancarlo Salsano,
  • Alessandro Sgreccia,
  • Eytan Raz,
  • Julien Burel,
  • Khawaja Muhammad Baqir Hassan,
  • Zhe Ji,
  • Riitta Rautio,
  • Maria Ruggiero,
  • Valerio Da Ros,
  • Joseph Domenico Gabrieli,
  • Michael Levitt,
  • Antonio Armando Caragliano,
  • Christophe Cognard,
  • Gaultier Marnat,
  • Nicola Limbucci,
  • Mariangela Piano,
  • Alexis Guedon,
  • Andrea Romi,
  • Fortunato Di Caterino,
  • Vyval Mykola,
  • Ocílio Ribeiro Gonçalves,
  • Adrien Guenego,
  • Mohamad Abdalkader,
  • Thanh Nguyen,
  • Vitor M. Pereira,
  • Erwah Kalsoum,
  • Aldobrando Broccolini,
  • Alessandro Pedicelli,
  • Luca Scarcia,
  • Andrea M. Alexandre

摘要

Background

Anatomical variants of the anterior cerebral artery (ACA) may increase technical complexity during endovascular treatment of distal ACA aneurysms (DACA). However, their impact on treatment outcomes remains unclear. This study evaluated whether ACA variants influence angiographic and clinical outcomes following endovascular treatment.

Methods

A retrospective multicenter analysis was conducted using data from the CRETA Registry, including patients with ruptured and unruptured DACA treated endovascularly. Patients were grouped according to ACA anatomy (variant vs. conventional). Outcomes were compared after propensity score matching (PSM) to adjust for confounders including age, aneurysm rupture status, dome-to-neck ratio, branch origin, and treatment type. The primary outcome was aneurysm occlusion at last follow-up based on the Raymond–Roy classification. Secondary outcomes included ischemic and hemorrhagic complications, vasospasm, and clinical outcome measured by the modified Rankin Scale (mRS).

Results

After PSM, 128 patients were included (64 per group). Among patients with available imaging follow-up (54 in the conventional group and 55 in the variant group), adequate occlusion rates were comparable between the variant and conventional ACA groups (81.5% vs. 85.5%; p = 0.600). No significant differences were observed in ischemic or hemorrhagic complications, vasospasm, or long-term clinical outcomes. Sensitivity analyses confirmed the robustness of the findings.

Conclusions

ACA anatomical variants do not adversely affect the safety or efficacy of endovascular treatment for DACA. With appropriate anatomical assessment and treatment selection, endovascular therapy remains effective even in the presence of complex ACA configurations.