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