Comparison of the Safety and Efficacy Between Flow Diverters and Stent-Assisted Coil Embolization for the Treatment of Anterior Cerebral Artery Dissecting Aneurysms: A Single-Center Retrospective Analysis

Comparison of the Safety and Efficacy Between Flow Diverters and Stent-Assisted Coil Embolization for the Treatment of Anterior Cerebral Artery Dissecting Aneurysms: A Single-Center Retrospective Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of the Safety and Efficacy Between Flow Diverters and Stent-Assisted Coil Embolization for the Treatment of Anterior Cerebral Artery Dissecting Aneurysms: A Single-Center Retrospective Analysis Hong Kuang, Shengchao Liao, Jingzhan Wu, Fei Long, Xianfang Guo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6652696/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract To investigate the safety and effectiveness of endovascular treatment for anterior cerebral artery (ACA) dissecting aneurysms. We retrospectively analyzed the clinical data of 11 patients with ACA dissecting aneurysms admitted to the Second Affiliated Hospital of Guangxi Medical University from January 2017 to December 2023. The clinical characteristics, aneurysm morphological features, treatment effects, and follow-up results of the two groups were analyzed. Three patients received Tubridge flow diverter (TFD group), and 8 patients underwent stent-assisted coil embolization (SAC group). The results showed that the mean age of the TFD group (43.67 ± 2.31 years) was lower than the SAC group (59.00 ± 8.28 years) (P = 0.012). In the SAC group, 75% of patients initially presented with subarachnoid hemorrhage(SAH), whereas there were no cases of SAH in the TFD group (P = 0.034). During follow-up, no aneurysm recurrence was observed in either group. In the SAC group, one patient (12.5%) experienced the complication of cerebral infarction. In conclusion, both flow diverters and SAC are safe and effective treatments for ACA dissecting aneurysms. SAC may be more suitable for saccular aneurysms with acute hemorrhage, while flow diverters may be a better option for fusiform aneurysms. Aneurysm morphology may be an important consideration in treatment selection. anterior cerebral artery dissecting aneurysm flow diverter stent-assisted embolization endovascular therapy Figures Figure 1 INTRODUCTION Endovascular treatment techniques for intracranial aneurysms have developed rapidly over the past two decades. Anterior cerebral artery (ACA) dissecting aneurysms are rare and challenging conditions due to their deep anatomical location, high variability, and the abundance of perforating arteries, all of which contribute to the difficulties associated with traditional surgery[ 1 ]. Traditional microsurgical clipping or bypass carries a high risk of complications, including traumatic surgical approaches, limited operative space, and potential injury to perforating arteries during the procedure[ 2 , 3 ]. Simple coil embolization is often ineffective for wide-necked and irregular aneurysms and has a high recurrence rate[ 4 , 5 ]. In recent years, with the advancement of endovascular treatment technologies, the application of flow-diverting devices has continuously expanded. Multiple studies have shown good safety and effectiveness of flow-diverting devices in treating complex intracranial aneurysms[ 6 – 8 ]. Meta-analyses indicate that the complete or near-complete occlusion rate of aneurysms using flow-diverting devices can reach76%-93.6%[ 6 , 7 ]. However, current research on the optimal treatment strategy for ACA dissecting aneurysms is limited, especially lacking individualized treatment plans based on aneurysm location and morphological characteristics. Stent-assisted coiling (SAC) and flow diverters (such as Tubridge) provide different treatment options for ACA dissecting aneurysms. SAC can immediately occlude the aneurysm and reduce the risk of rupture; while flow diverters achieve long-term stable therapeutic effects through vascular wall reconstruction[ 9 – 11 ]. These two therapeutic strategies have their respective advantages in treating ACA dissecting aneurysms, requiring case-specific selection of appropriate treatment plans, and further research and validation are needed to evaluate their safety and efficacy. This study aims to retrospectively analyze our hospital's clinical experience in treating ACA dissecting aneurysms with SAC or Tubrige, investigate the safety and effectiveness of this treatment strategy, and provide a reference for developing the optimal treatment plan. MATERIALS AND METHODS Study Subjects and Inclusion Criteria From January 2017 to December 2023, the Second Affiliated Hospital of Guangxi Medical University diagnosed a total of 25 patients with ACA dissecting aneurysms. The diagnosis of patients was based on meeting one of the following criteria: (1) Digital Subtraction Angiography (DSA) showing typical pearl-on-string sign, irregular luminal stenosis or dilatation; (2) Time-of-Flight Magnetic Resonance Angiography (TOF-MRA) displaying intramural hematoma, double-lumen sign, or intimal flap; (3) Pathological aneurysm located in ACA and its branches, accompanied by characteristic segmental expansion. Among the 25 patients, 11 underwent endovascular intervention and were included in this study. We retrospectively collected patient baseline data, including age, gender, initial clinical presentation, aneurysm angiographic classification, and risk factors (hypertension, diabetes, etc.). Surgical Methods The hospital's Institutional Review Board approved this study. All patients underwent endovascular treatment through right femoral artery puncture under general anesthesia. Different treatment strategies were adopted based on aneurysm morphological characteristics For saccular ruptured aneurysms, SAC is primarily used, with LIVS (MicroVention, Tustin, CA, USA) selected as the stent. Forflow-diverting devices (Tubrige, MicroPort Medical Company, Shanghai, China) were employed for fusiform aneurysms. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Antiplatelet Treatment Regimen For elective surgery patients, oral aspirin (100mg/d) and clopidogrel (75mg/d) were administered 7 days before surgery. Emergency surgery patients received immediate loading doses (aspirin 300mg, clopidogrel 300mg) post-operation. For patients with cerebral infarction, dual antiplatelet therapy was initiated one month after the infarction. Follow-up and Evaluation Methods: All patients underwent CT examination within 24 hours post-operation. DSA follow-up was performed at 6 months, 12 months, and 24 months after surgery. For patients developing new neurological symptoms, additional MRI diffusion-weighted imaging (DWI) was performed. The modified Rankin Scale (mRS) was used to evaluate neurological function at each follow-up. Treatment outcome was considered favorable when mRS score ≤ 2. Statistical Analysis Statistical analysis was performed using IBM SPSS Statistics version 28.0 (IBM Corp., Armonk, NY, USA). The Shapiro-Wilk test was used to assess the normality of continuous variables due to the small sample size. Continuous variables are presented as mean ± standard deviation when normally distributed and were compared using independent sample t-tests. For non-normally distributed continuous variables, data are expressed as median (interquartile range) and were analyzed using Mann-Whitney U tests. Categorical variables are presented as frequencies (percentages) and were analyzed using Fisher's exact test given the small sample size. All statistical tests were two-tailed, and P values < 0.05 were considered statistically significant. RESULTS Baseline Characteristics Among the 11 patients included in this study, 3 received Tubridge treatment (TFD group) and 8 underwent stent-assisted coiling (SAC group). The mean age of the TFD group (43.67 ± 2.31 years) was significantly lower than the SAC group (59.00 ± 8.28 years) (P = 0.012). Male proportion was similar between groups (TFD: 66.7%, 2/3; SAC: 62.5%, 5/8). Hypertension was present in 33.3% (1/3) of TFD patients and 50.0% (4/8) of SAC patients. The mean follow-up duration was 30.33 ± 3.51 months for the TFD group and 26.38 ± 3.20 months for the SAC group (P = 0.087)(Table 2). Aneurysm Characteristics and Initial Presentation Regarding aneurysm morphology, the SAC group predominantly presented with saccular aneurysms (87.5%), while the TFD group mainly showed fusiform aneurysms (66.7%) (P = 0.108). Mean aneurysm dimensions in the TFD group (length: 10.50 ± 5.23mm, width: 9.13 ± 5.61mm) exceeded those in the SAC group (length: 6.71 ± 3.85mm, width: 5.13 ± 2.30mm), though not significantly (P = 0.197, P = 0.103). Initial SAH occurred in 75% (6/8) of SAC patients but in none of the TFD group (P = 0.034). Initial cerebral infarction was observed in 33.3% (1/3) of TFD patients and 12.5% (1/8) of SAC patients (P = 0.455) (Table 2). Treatment Outcomes and Complications Technical success was achieved in all cases. One patient (12.5%) in the SAC group developed a new cerebral infarction during the perioperative period, which improved after rehabilitation therapy, resulting in a final mRS score of 3. There were no new complications in the TFD group (P = 1.000). No aneurysm recurrence was observed in either group during the follow-up period. The initial mRS scores were 0.67 ± 0.58 in the TFD group and 1.75 ± 1.67 in the SAC group (P = 0.456). At the final follow-up, the mRS score was 0.33 ± 0.58 in the TFD group and 0.75 ± 1.04 in the SAC group (P = 0.521), with no statistically significant difference. (Table 3). DISCUSSION The diagnosis rate of dissecting aneurysms with SAH or focal ischemia is increasing among young and middle-aged individuals [ 12 , 13 ]. The complex anatomical features of dissecting aneurysms, including their beaded appearance, intramural hematoma, and intimal flap, not only increase the difficulty of treatment but also lead to significant incidence of complications and risk of mortality. Therefore, endovascular intervention is considered the preferred treatment option for these types of aneurysms[ 14 , 15 ], Although dissecting aneurysms have a lower incidence, they carry a higher risk of recurrence after treatment (13–17%). This is mainly due to their more fragile vascular wall and the characteristic of persistent blood flow within the residual aneurysm sac towards branching vessels, which increases the likelihood of recurrence[ 16 – 18 ]. Increasing the metal coverage of the stent neck can reduce the risk of recurrence, primarily by minimizing impact on blood flow to prevent coil compaction due to embolization, and by reducing shear stress on the aneurysm wall to inhibit its further growth[ 18 ]. Wall shear stress has been found to play a significant role in aneurysm recurrence. The LVIS stent has a mesh size of 0.9 mm, exerts a certain hemodynamic effect on cerebral aneurysms, and has been successfully used to treat wide-necked and dissecting aneurysms[ 19 – 22 ]. Research has confirmed that reducing porosity through stent overlapping techniques, instead of using flow diverters, is a feasible approach to lower the recurrence rate of intracranial dissecting aneurysms[ 23 ]. In this study, because the ACA is relatively small, using a single LVIS stent can effectively increase metal coverage. It may provide better protection against coil protrusion and yield improved flow diversion. Our investigation demonstrates that both TFD and SAC represent safe and efficacious treatment modalities for ACA dissecting aneurysms, with patients in both cohorts achieving satisfactory functional outcomes. Comparative analysis of final mRS scores revealed no statistically significant difference between the two treatment groups (TFD group: 0.33 ± 0.58; SAC group: 0.75 ± 1.04; P = 0.521), confirming that both techniques can deliver favorable clinical results when appropriately selected for individual cases. The marginally superior mRS scores observed in the TFD cohort likely reflect their younger demographic profile and the absence of initial hemorrhagic presentation. Several additional findings from our analysis warrant further discussion. First, the initial clinical presentation differed significantly between groups, with SAH present in 75% of SAC patients but absent in TFD patients (P = 0.034). Studies have shown that aneurysm protection via immediate coil embolization is often required in the management of acute hemorrhagic cases, which can effectively prevent rebleeding[ 24 , 25 ]. In our study, flow diverters were selected for the treatment of fusiform dissecting aneurysms (66.7%) and also achieved good results. Some studies indicate that flow diverters are the preferred treatment for fusiform aneurysms because they induce thrombosis within the aneurysm and simultaneously promote endothelialization at the aneurysm neck, effectively reconstructing the vessel wall[ 26 , 27 ]. They promote thrombosis within the aneurysm sac and stimulate neo-intimal growth in the neck region, preventing aneurysm growth and rupture and leading to complete occlusion. More importantly, this healing process preserves the patency of the parent artery and adjacent branch vessels[ 28 ]. Evidence shows that flow diverters have high long-term angiographic occlusion rates for refractory large and giant wide-necked internal carotid artery aneurysms, and previously occluded lesions do not recanalize[ 7 ]. In addition, the significant age difference between the groups (TFD group: 43.67 ± 2.31 years vs. SAC group: 59.00 ± 8.28 years; P = 0.012) may indicate unique natural progression patterns for different aneurysm morphologies. Research shows that fusiform/dissecting aneurysms primarily affect young and middle-aged individuals, with a significantly higher incidence in males than females[ 29 – 32 ]. Their etiology is not yet fully understood, and although a considerable number of cases are idiopathic, they are also observed in patients with a history of trauma, surgical procedures, or infection Currently, these types of aneurysms are believed to be acquired lesions caused by "vascular wall dysfunction," rather than congenital vascular diseases[ 31 ]. Our research indicates that the TFD group was younger, which aligns with existing observations suggesting that fusiform aneurysms may tend to occur earlier. Further research is needed to confirm this. Thirdly, both treatment methods demonstrated good safety profiles. Third, both treatment methods demonstrated good safety profiles. Although one patient in the SAC group (12.5%) experienced frontal lobe infarction during the perioperative period. Research suggests that the incidence of thromboembolic events associated with SAC ranges from 4.7–17%, and the incidence of thrombotic complications is significantly higher in patients with SAH compared to those without SAH[ 9 , 33 – 35 ]. However, this patient's mRS score upon admission was 5 due to severe SAH and subsequently developed hydrocephalus. After treatment, their mRS score improved to 3, and the less than optimal treatment outcome cannot be solely attributed to the cerebral infarction. During the follow-up period (mean 30.33 ± 3.51 months for the TFD group and 26.38 ± 3.20 months for the SAC group), no aneurysm recurrence was observed in either group, indicating that both treatment methods have good long-term efficacy. Thromboembolic events occurring during the perioperative period of stent implantation can lead to occlusion of large or branch vessels, potentially causing serious complications, which poses a significant challenge for neurosurgeons. Studies show that preoperative antiplatelet pretreatment can effectively reduce the risk of thromboembolic events during SAC treatment for ruptured aneurysms, while bleeding complications related to external ventricular drainage are uncommon[ 36 , 37 ]. Furthermore, given the urgency of treating acute SAH and the hypercoagulable state induced by SAH, the risk of thrombosis should be fully evaluated. In this study, due to the limited sample size, there was no statistically significant difference in the incidence of ischemic complications between the SAC group and the TFD group. The SAC group exhibited a higher incidence of thrombotic complications, which can be attributed to three primary factors: inadequate preoperative antiplatelet therapy, endothelial damage during stent deployment, and incomplete stent apposition against the vessel wall. Our findings suggest that implementing a rigorous dual antiplatelet therapy regimen and meticulous monitoring of platelet aggregation levels can effectively mitigate these risks. Study Limitations Several limitations of this study should be considered when interpreting the results. First, the small sample size may affect the reliability of comparisons between groups. Second, as a single-center, retrospective study, selection bias cannot be ruled out. Larger-scale, multi-center studies with extended follow-up periods are needed in the future to further validate our findings. Simultaneously, it is crucial to investigate the value of in-depth research on aneurysm morphology characteristics for predicting treatment outcomes. Comprehensive analysis of aneurysm morphological features to establish standardized criteria for treatment option selection will contribute to further improvements in treatment efficacy. CONCLUSION This investigation demonstrates that both flow-diverting devices and SAC can achieve favorable clinical outcomes in the management of ACA dissecting aneurysms when strategically selected. Our findings emphasize that treatment approaches should be tailored to individual patients, taking into careful consideration the aneurysm morphology, initial clinical presentation, and patient-specific factors. Flow-diverting devices appear particularly beneficial for fusiform aneurysms, offering superior vessel reconstruction and flow remodeling. In comparison, SAC demonstrates enhanced efficacy in addressing saccular aneurysms, especially in the acute hemorrhagic setting where rapid occlusion is essential. Given the limitations of our current sample size, larger prospective multicenter studies with extended follow-up periods are warranted to further validate the long-term effectiveness and safety profiles of these therapeutic strategies. Declarations Clinical trial number Not applicable. Ethics approval The study was approved by the institutional review board (No.2023-KY-0944). Consent to participate Not applicable. Consent for publication Informed consent was obtained from the patient for publication of the picture. Competing interests The authors declare no competing interests. Funding This research was supported by the Natural Science Foundation of Guangxi Zhuang Autonomous Region (2025GXNSFAA069063), the Basic Ability Enhancement Project of Young Teachers in Guangxi Zhuang Autonomous Region [2021KY0089]. Author Contribution HK conceptualized the idea, revised and edited the final version of the manuscript. HK interpreted the data and drafted the manuscript. 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Am J Neuroradiol 36:1682–1688. https://doi.org/10.3174/ajnr.A4365 Bodily KD, Cloft HJ, Lanzino G et al (2011) Stent-assisted coiling in acutely ruptured intracranial aneurysms: a qualitative, systematic review of the literature. Am J Neuroradiol 32:1232–1236. https://doi.org/10.3174/ajnr.A2478 Qoorchi Moheb Seraj F, Mirbolouk MH, Vaezi M et al (2023) Safety of dual antiplatelet therapy in the acute phase of aneurysmal subarachnoid hemorrhage: a propensity score-matched study. Neurosurg Focus 55:E10. https://doi.org/10.3171/2023.7.FOCUS23376 Samaniego EA, Gibson E, Nakagawa D et al (2019) Safety of tirofiban and dual antiplatelet therapy in treating intracranial aneurysms. Stroke Vasc Neurol 4:36–42. https://doi.org/10.1136/svn-2018-000192 Tables Tables 1 to 3 are available in the Supplementary Files section. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6652696","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":458795437,"identity":"afefe3af-4db9-490a-842c-8bc269a6e2f3","order_by":0,"name":"Hong Kuang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYBACCRDB2AAkmBkbH3yokJDjJ14LO/NhwxlnLIwlG4jWws+WJs3bVpG4gZAWyRnJzx5+3WGTJ+/MY2w4c54E4wYG5oePbuDRIi2RZm4seyat2PAwj+GDj9skmM0Z2IyNc/BokZNIMJOWbDucuLEZZMs2CTbLBh42afxa0r/BtJhJ886R4DE4QECLtESOmeRHoJb5zCDvN0hIENQi2fOmTJqxLS1xAzMokI9JGEg2E/CLxPH0bZI/22wS5/cfBEZlTV19P3vzw8f4tIAAMw+QMDgA5xJQDgKMP4CEfAMRKkfBKBgFo2BkAgBayUsd5cnQGAAAAABJRU5ErkJggg==","orcid":"","institution":"The Second Affiliated Hospital of Guangxi Medical University","correspondingAuthor":true,"prefix":"","firstName":"Hong","middleName":"","lastName":"Kuang","suffix":""},{"id":458795438,"identity":"6a7fd44d-853d-4b5d-9c65-9f72239838f9","order_by":1,"name":"Shengchao Liao","email":"","orcid":"","institution":"The Second Affiliated Hospital of Guangxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shengchao","middleName":"","lastName":"Liao","suffix":""},{"id":458795439,"identity":"13843691-fba5-421a-b449-d3d6afdf0e05","order_by":2,"name":"Jingzhan Wu","email":"","orcid":"","institution":"The Second Affiliated Hospital of Guangxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jingzhan","middleName":"","lastName":"Wu","suffix":""},{"id":458795440,"identity":"72184dfd-42ab-466a-953d-c7f1afd9dd0c","order_by":3,"name":"Fei Long","email":"","orcid":"","institution":"The Second Affiliated Hospital of Guangxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Fei","middleName":"","lastName":"Long","suffix":""},{"id":458795441,"identity":"844f9ace-1245-46dd-baaf-7e80714572ff","order_by":4,"name":"Xianfang Guo","email":"","orcid":"","institution":"The Second Affiliated Hospital of Guangxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xianfang","middleName":"","lastName":"Guo","suffix":""}],"badges":[],"createdAt":"2025-05-13 07:38:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6652696/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6652696/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83337670,"identity":"0f9628dd-0c11-4c44-9c3a-1673829582d2","added_by":"auto","created_at":"2025-05-23 09:38:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":6989375,"visible":true,"origin":"","legend":"\u003cp\u003ePlease see the image above for figure legend.\u003c/p\u003e","description":"","filename":"figures.png","url":"https://assets-eu.researchsquare.com/files/rs-6652696/v1/ad729298862e92d3a50cc519.png"},{"id":88189043,"identity":"e7233e62-031b-45b9-8939-fc41b7b9f8eb","added_by":"auto","created_at":"2025-08-03 13:01:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":6950966,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6652696/v1/c7ca6ce7-4230-4306-a845-753179874a95.pdf"},{"id":83337393,"identity":"6590bf58-defe-468a-a853-1ecf6a8ff2c0","added_by":"auto","created_at":"2025-05-23 09:30:01","extension":"tif","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":961224,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.tif","url":"https://assets-eu.researchsquare.com/files/rs-6652696/v1/199e2f24d165213b05267097.tif"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of the Safety and Efficacy Between Flow Diverters and Stent-Assisted Coil Embolization for the Treatment of Anterior Cerebral Artery Dissecting Aneurysms: A Single-Center Retrospective Analysis","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eEndovascular treatment techniques for intracranial aneurysms have developed rapidly over the past two decades. Anterior cerebral artery (ACA) dissecting aneurysms are rare and challenging conditions due to their deep anatomical location, high variability, and the abundance of perforating arteries, all of which contribute to the difficulties associated with traditional surgery[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Traditional microsurgical clipping or bypass carries a high risk of complications, including traumatic surgical approaches, limited operative space, and potential injury to perforating arteries during the procedure[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Simple coil embolization is often ineffective for wide-necked and irregular aneurysms and has a high recurrence rate[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn recent years, with the advancement of endovascular treatment technologies, the application of flow-diverting devices has continuously expanded. Multiple studies have shown good safety and effectiveness of flow-diverting devices in treating complex intracranial aneurysms[\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Meta-analyses indicate that the complete or near-complete occlusion rate of aneurysms using flow-diverting devices can reach76%-93.6%[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, current research on the optimal treatment strategy for ACA dissecting aneurysms is limited, especially lacking individualized treatment plans based on aneurysm location and morphological characteristics.\u003c/p\u003e \u003cp\u003eStent-assisted coiling (SAC) and flow diverters (such as Tubridge) provide different treatment options for ACA dissecting aneurysms. SAC can immediately occlude the aneurysm and reduce the risk of rupture; while flow diverters achieve long-term stable therapeutic effects through vascular wall reconstruction[\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. These two therapeutic strategies have their respective advantages in treating ACA dissecting aneurysms, requiring case-specific selection of appropriate treatment plans, and further research and validation are needed to evaluate their safety and efficacy.\u003c/p\u003e \u003cp\u003eThis study aims to retrospectively analyze our hospital's clinical experience in treating ACA dissecting aneurysms with SAC or Tubrige, investigate the safety and effectiveness of this treatment strategy, and provide a reference for developing the optimal treatment plan.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Subjects and Inclusion Criteria\u003c/h2\u003e \u003cp\u003eFrom January 2017 to December 2023, the Second Affiliated Hospital of Guangxi Medical University diagnosed a total of 25 patients with ACA dissecting aneurysms. The diagnosis of patients was based on meeting one of the following criteria: (1) Digital Subtraction Angiography (DSA) showing typical pearl-on-string sign, irregular luminal stenosis or dilatation; (2) Time-of-Flight Magnetic Resonance Angiography (TOF-MRA) displaying intramural hematoma, double-lumen sign, or intimal flap; (3) Pathological aneurysm located in ACA and its branches, accompanied by characteristic segmental expansion. Among the 25 patients, 11 underwent endovascular intervention and were included in this study. We retrospectively collected patient baseline data, including age, gender, initial clinical presentation, aneurysm angiographic classification, and risk factors (hypertension, diabetes, etc.).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSurgical Methods\u003c/h3\u003e\n\u003cp\u003e The hospital's Institutional Review Board approved this study. All patients underwent endovascular treatment through right femoral artery puncture under general anesthesia. Different treatment strategies were adopted based on aneurysm morphological characteristics For saccular ruptured aneurysms, SAC is primarily used, with LIVS (MicroVention, Tustin, CA, USA) selected as the stent. Forflow-diverting devices (Tubrige, MicroPort Medical Company, Shanghai, China) were employed for fusiform aneurysms.\u003c/p\u003e \u003cp\u003e All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003ch3\u003eAntiplatelet Treatment Regimen\u003c/h3\u003e\n\u003cp\u003eFor elective surgery patients, oral aspirin (100mg/d) and clopidogrel (75mg/d) were administered 7 days before surgery. Emergency surgery patients received immediate loading doses (aspirin 300mg, clopidogrel 300mg) post-operation. For patients with cerebral infarction, dual antiplatelet therapy was initiated one month after the infarction.\u003c/p\u003e \u003cp\u003eFollow-up and Evaluation Methods:\u003c/p\u003e \u003cp\u003eAll patients underwent CT examination within 24 hours post-operation. DSA follow-up was performed at 6 months, 12 months, and 24 months after surgery. For patients developing new neurological symptoms, additional MRI diffusion-weighted imaging (DWI) was performed. The modified Rankin Scale (mRS) was used to evaluate neurological function at each follow-up. Treatment outcome was considered favorable when mRS score\u0026thinsp;\u0026le;\u0026thinsp;2.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using IBM SPSS Statistics version 28.0 (IBM Corp., Armonk, NY, USA). The Shapiro-Wilk test was used to assess the normality of continuous variables due to the small sample size. Continuous variables are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation when normally distributed and were compared using independent sample t-tests. For non-normally distributed continuous variables, data are expressed as median (interquartile range) and were analyzed using Mann-Whitney U tests. Categorical variables are presented as frequencies (percentages) and were analyzed using Fisher's exact test given the small sample size. All statistical tests were two-tailed, and P values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eBaseline Characteristics\u003c/h2\u003e \u003cp\u003eAmong the 11 patients included in this study, 3 received Tubridge treatment (TFD group) and 8 underwent stent-assisted coiling (SAC group). The mean age of the TFD group (43.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31 years) was significantly lower than the SAC group (59.00\u0026thinsp;\u0026plusmn;\u0026thinsp;8.28 years) (P\u0026thinsp;=\u0026thinsp;0.012). Male proportion was similar between groups (TFD: 66.7%, 2/3; SAC: 62.5%, 5/8). Hypertension was present in 33.3% (1/3) of TFD patients and 50.0% (4/8) of SAC patients. The mean follow-up duration was 30.33\u0026thinsp;\u0026plusmn;\u0026thinsp;3.51 months for the TFD group and 26.38\u0026thinsp;\u0026plusmn;\u0026thinsp;3.20 months for the SAC group (P\u0026thinsp;=\u0026thinsp;0.087)(Table\u0026nbsp;2).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAneurysm Characteristics and Initial Presentation\u003c/h3\u003e\n\u003cp\u003eRegarding aneurysm morphology, the SAC group predominantly presented with saccular aneurysms (87.5%), while the TFD group mainly showed fusiform aneurysms (66.7%) (P\u0026thinsp;=\u0026thinsp;0.108). Mean aneurysm dimensions in the TFD group (length: 10.50\u0026thinsp;\u0026plusmn;\u0026thinsp;5.23mm, width: 9.13\u0026thinsp;\u0026plusmn;\u0026thinsp;5.61mm) exceeded those in the SAC group (length: 6.71\u0026thinsp;\u0026plusmn;\u0026thinsp;3.85mm, width: 5.13\u0026thinsp;\u0026plusmn;\u0026thinsp;2.30mm), though not significantly (P\u0026thinsp;=\u0026thinsp;0.197, P\u0026thinsp;=\u0026thinsp;0.103). Initial SAH occurred in 75% (6/8) of SAC patients but in none of the TFD group (P\u0026thinsp;=\u0026thinsp;0.034). Initial cerebral infarction was observed in 33.3% (1/3) of TFD patients and 12.5% (1/8) of SAC patients (P\u0026thinsp;=\u0026thinsp;0.455) (Table\u0026nbsp;2).\u003c/p\u003e\n\u003ch3\u003eTreatment Outcomes and Complications\u003c/h3\u003e\n\u003cp\u003eTechnical success was achieved in all cases. One patient (12.5%) in the SAC group developed a new cerebral infarction during the perioperative period, which improved after rehabilitation therapy, resulting in a final mRS score of 3. There were no new complications in the TFD group (P\u0026thinsp;=\u0026thinsp;1.000). No aneurysm recurrence was observed in either group during the follow-up period. The initial mRS scores were 0.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58 in the TFD group and 1.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.67 in the SAC group (P\u0026thinsp;=\u0026thinsp;0.456). At the final follow-up, the mRS score was 0.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58 in the TFD group and 0.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04 in the SAC group (P\u0026thinsp;=\u0026thinsp;0.521), with no statistically significant difference. (Table\u0026nbsp;3).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe diagnosis rate of dissecting aneurysms with SAH or focal ischemia is increasing among young and middle-aged individuals [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The complex anatomical features of dissecting aneurysms, including their beaded appearance, intramural hematoma, and intimal flap, not only increase the difficulty of treatment but also lead to significant incidence of complications and risk of mortality. Therefore, endovascular intervention is considered the preferred treatment option for these types of aneurysms[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], Although dissecting aneurysms have a lower incidence, they carry a higher risk of recurrence after treatment (13\u0026ndash;17%). This is mainly due to their more fragile vascular wall and the characteristic of persistent blood flow within the residual aneurysm sac towards branching vessels, which increases the likelihood of recurrence[\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Increasing the metal coverage of the stent neck can reduce the risk of recurrence, primarily by minimizing impact on blood flow to prevent coil compaction due to embolization, and by reducing shear stress on the aneurysm wall to inhibit its further growth[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Wall shear stress has been found to play a significant role in aneurysm recurrence. The LVIS stent has a mesh size of 0.9 mm, exerts a certain hemodynamic effect on cerebral aneurysms, and has been successfully used to treat wide-necked and dissecting aneurysms[\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Research has confirmed that reducing porosity through stent overlapping techniques, instead of using flow diverters, is a feasible approach to lower the recurrence rate of intracranial dissecting aneurysms[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In this study, because the ACA is relatively small, using a single LVIS stent can effectively increase metal coverage. It may provide better protection against coil protrusion and yield improved flow diversion. Our investigation demonstrates that both TFD and SAC represent safe and efficacious treatment modalities for ACA dissecting aneurysms, with patients in both cohorts achieving satisfactory functional outcomes. Comparative analysis of final mRS scores revealed no statistically significant difference between the two treatment groups (TFD group: 0.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58; SAC group: 0.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04; P\u0026thinsp;=\u0026thinsp;0.521), confirming that both techniques can deliver favorable clinical results when appropriately selected for individual cases. The marginally superior mRS scores observed in the TFD cohort likely reflect their younger demographic profile and the absence of initial hemorrhagic presentation. Several additional findings from our analysis warrant further discussion. First, the initial clinical presentation differed significantly between groups, with SAH present in 75% of SAC patients but absent in TFD patients (P\u0026thinsp;=\u0026thinsp;0.034). Studies have shown that aneurysm protection via immediate coil embolization is often required in the management of acute hemorrhagic cases, which can effectively prevent rebleeding[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In our study, flow diverters were selected for the treatment of fusiform dissecting aneurysms (66.7%) and also achieved good results. Some studies indicate that flow diverters are the preferred treatment for fusiform aneurysms because they induce thrombosis within the aneurysm and simultaneously promote endothelialization at the aneurysm neck, effectively reconstructing the vessel wall[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. They promote thrombosis within the aneurysm sac and stimulate neo-intimal growth in the neck region, preventing aneurysm growth and rupture and leading to complete occlusion. More importantly, this healing process preserves the patency of the parent artery and adjacent branch vessels[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Evidence shows that flow diverters have high long-term angiographic occlusion rates for refractory large and giant wide-necked internal carotid artery aneurysms, and previously occluded lesions do not recanalize[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn addition, the significant age difference between the groups (TFD group: 43.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31 years vs. SAC group: 59.00\u0026thinsp;\u0026plusmn;\u0026thinsp;8.28 years; P\u0026thinsp;=\u0026thinsp;0.012) may indicate unique natural progression patterns for different aneurysm morphologies. Research shows that fusiform/dissecting aneurysms primarily affect young and middle-aged individuals, with a significantly higher incidence in males than females[\u003cspan additionalcitationids=\"CR30 CR31\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Their etiology is not yet fully understood, and although a considerable number of cases are idiopathic, they are also observed in patients with a history of trauma, surgical procedures, or infection Currently, these types of aneurysms are believed to be acquired lesions caused by \"vascular wall dysfunction,\" rather than congenital vascular diseases[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Our research indicates that the TFD group was younger, which aligns with existing observations suggesting that fusiform aneurysms may tend to occur earlier. Further research is needed to confirm this.\u003c/p\u003e \u003cp\u003eThirdly, both treatment methods demonstrated good safety profiles. Third, both treatment methods demonstrated good safety profiles. Although one patient in the SAC group (12.5%) experienced frontal lobe infarction during the perioperative period. Research suggests that the incidence of thromboembolic events associated with SAC ranges from 4.7\u0026ndash;17%, and the incidence of thrombotic complications is significantly higher in patients with SAH compared to those without SAH[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan additionalcitationids=\"CR34\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. However, this patient's mRS score upon admission was 5 due to severe SAH and subsequently developed hydrocephalus. After treatment, their mRS score improved to 3, and the less than optimal treatment outcome cannot be solely attributed to the cerebral infarction. During the follow-up period (mean 30.33\u0026thinsp;\u0026plusmn;\u0026thinsp;3.51 months for the TFD group and 26.38\u0026thinsp;\u0026plusmn;\u0026thinsp;3.20 months for the SAC group), no aneurysm recurrence was observed in either group, indicating that both treatment methods have good long-term efficacy. Thromboembolic events occurring during the perioperative period of stent implantation can lead to occlusion of large or branch vessels, potentially causing serious complications, which poses a significant challenge for neurosurgeons. Studies show that preoperative antiplatelet pretreatment can effectively reduce the risk of thromboembolic events during SAC treatment for ruptured aneurysms, while bleeding complications related to external ventricular drainage are uncommon[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Furthermore, given the urgency of treating acute SAH and the hypercoagulable state induced by SAH, the risk of thrombosis should be fully evaluated. In this study, due to the limited sample size, there was no statistically significant difference in the incidence of ischemic complications between the SAC group and the TFD group. The SAC group exhibited a higher incidence of thrombotic complications, which can be attributed to three primary factors: inadequate preoperative antiplatelet therapy, endothelial damage during stent deployment, and incomplete stent apposition against the vessel wall. Our findings suggest that implementing a rigorous dual antiplatelet therapy regimen and meticulous monitoring of platelet aggregation levels can effectively mitigate these risks.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStudy Limitations\u003c/h2\u003e \u003cp\u003eSeveral limitations of this study should be considered when interpreting the results. First, the small sample size may affect the reliability of comparisons between groups. Second, as a single-center, retrospective study, selection bias cannot be ruled out. Larger-scale, multi-center studies with extended follow-up periods are needed in the future to further validate our findings. Simultaneously, it is crucial to investigate the value of in-depth research on aneurysm morphology characteristics for predicting treatment outcomes. Comprehensive analysis of aneurysm morphological features to establish standardized criteria for treatment option selection will contribute to further improvements in treatment efficacy.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis investigation demonstrates that both flow-diverting devices and SAC can achieve favorable clinical outcomes in the management of ACA dissecting aneurysms when strategically selected. Our findings emphasize that treatment approaches should be tailored to individual patients, taking into careful consideration the aneurysm morphology, initial clinical presentation, and patient-specific factors. Flow-diverting devices appear particularly beneficial for fusiform aneurysms, offering superior vessel reconstruction and flow remodeling. In comparison, SAC demonstrates enhanced efficacy in addressing saccular aneurysms, especially in the acute hemorrhagic setting where rapid occlusion is essential. Given the limitations of our current sample size, larger prospective multicenter studies with extended follow-up periods are warranted to further validate the long-term effectiveness and safety profiles of these therapeutic strategies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eClinical trial number\u003c/h2\u003e \u003cp\u003e Not applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003cstrong\u003eEthics approval\u003c/strong\u003e \u003cp\u003e The study was approved by the institutional review board (No.2023-KY-0944).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to participate\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003e Informed consent was obtained from the patient for publication of the picture.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research was supported by the Natural Science Foundation of Guangxi Zhuang Autonomous Region (2025GXNSFAA069063), the Basic Ability Enhancement Project of Young Teachers in Guangxi Zhuang Autonomous Region [2021KY0089].\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eHK conceptualized the idea, revised and edited the final version of the manuscript. HK interpreted the data and drafted the manuscript. HK and SL collect information and edited the manuscript. JW, SL, FL, XG analyzed the data. All the authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAvailability of data and material\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eCode availability\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOshiro S, Tsugu H, Sakamoto S et al (2007) Ruptured aneurysm of the distal anterior cerebral artery: clinical features and surgical strategies. Neurol Med Chir (Tokyo) 47:159\u0026ndash;164\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe Divitiis O, Di Somma A, Somma T et al (2015) Surgical clipping of a dissecting aneurysm of the precommunicating segment of the anterior cerebral artery: a case report and review of the literature. 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Stroke Vasc Neurol 4:36\u0026ndash;42. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/svn-2018-000192\u003c/span\u003e\u003cspan address=\"10.1136/svn-2018-000192\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"anterior cerebral artery, dissecting aneurysm, flow diverter, stent-assisted embolization, endovascular therapy","lastPublishedDoi":"10.21203/rs.3.rs-6652696/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6652696/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eTo investigate the safety and effectiveness of endovascular treatment for anterior cerebral artery (ACA) dissecting aneurysms. We retrospectively analyzed the clinical data of 11 patients with ACA dissecting aneurysms admitted to the Second Affiliated Hospital of Guangxi Medical University from January 2017 to December 2023. The clinical characteristics, aneurysm morphological features, treatment effects, and follow-up results of the two groups were analyzed. Three patients received Tubridge flow diverter (TFD group), and 8 patients underwent stent-assisted coil embolization (SAC group). The results showed that the mean age of the TFD group (43.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31 years) was lower than the SAC group (59.00\u0026thinsp;\u0026plusmn;\u0026thinsp;8.28 years) (P\u0026thinsp;=\u0026thinsp;0.012). In the SAC group, 75% of patients initially presented with subarachnoid hemorrhage(SAH), whereas there were no cases of SAH in the TFD group (P\u0026thinsp;=\u0026thinsp;0.034). During follow-up, no aneurysm recurrence was observed in either group. In the SAC group, one patient (12.5%) experienced the complication of cerebral infarction. In conclusion, both flow diverters and SAC are safe and effective treatments for ACA dissecting aneurysms. SAC may be more suitable for saccular aneurysms with acute hemorrhage, while flow diverters may be a better option for fusiform aneurysms. Aneurysm morphology may be an important consideration in treatment selection.\u003c/p\u003e","manuscriptTitle":"Comparison of the Safety and Efficacy Between Flow Diverters and Stent-Assisted Coil Embolization for the Treatment of Anterior Cerebral Artery Dissecting Aneurysms: A Single-Center Retrospective Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-23 09:29:55","doi":"10.21203/rs.3.rs-6652696/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0df74769-938a-4403-9896-7b9b9520643b","owner":[],"postedDate":"May 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-03T12:53:32+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-23 09:29:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6652696","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6652696","identity":"rs-6652696","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}