Endovascular treatment, particularly stent-assisted coiling, appears to be a safe and feasible option for ruptured anterior choroidal artery aneurysms, with potential for durable occlusion, though findings are hypothesis-generating given the small sample size.
No procedure-related mortality occurred in either the coiling-alone or stent-assisted coiling groups for ruptured anterior choroidal artery aneurysms treated within 72 hours of ictus.
The overall rate of ischemic events was higher in the SAC group than in the coiling-alone group.
Favorable clinical outcomes at 6 months were achieved at similarly high rates in both the coiling-alone and SAC groups.
SAC demonstrated a statistically significant reduction in aneurysm recurrence compared to coiling alone, though this finding has a fragility index of 1.
SAC showed a trend toward higher complete aneurysm occlusion compared to coiling alone, though this did not reach statistical significance.
No significant differences in outcomes were observed between dual antiplatelet therapy (DAPT) and intravenous tirofiban within the SAC subgroup.
This research examines how to safely treat a rare type of brain aneurysm — one located on the anterior choroidal artery — after it has ruptured and caused a hemorrhagic stroke. The study looked at 29 patients who received endovascular (catheter-based) treatment within 72 hours of their aneurysm rupturing. Some patients received standard coil embolization (inserting tiny metal coils to block off the aneurysm), while others received stent-assisted coiling (SAC), where a small mesh tube is placed in the artery to help hold the coils in place. The researchers found that both approaches were relatively safe, with no treatment-related deaths, and that about 90% of patients in both groups had good functional outcomes six months later. The main potential advantage of the stent-assisted approach was in preventing the aneurysm from coming back: none of the SAC patients had a recurrence compared to 27.3% in the coiling-alone group. However, the researchers caution that this finding is statistically fragile — changing the outcome of just one patient would make the result no longer significant — so it should be interpreted carefully. SAC was also associated with more ischemic (blood-clot-related) events during or after the procedure (27.8% vs 9.1%), though this did not translate into worse overall outcomes, possibly due to the small sample size. The study also found that two different blood-thinning strategies used during stent placement — a dual oral antiplatelet regimen versus an intravenous drug called tirofiban — appeared similarly safe and effective, though again the numbers were too small to draw firm conclusions. This research suggests that stent-assisted coiling may offer better long-term sealing of ruptured anterior choroidal artery aneurysms compared to coiling alone, but comes with a higher risk of clot-related complications during treatment. Because the study included only 29 patients and was retrospective (looking back at existing records rather than running a controlled trial), the authors emphasize that the findings are exploratory and need to be confirmed in larger, prospective studies before firm clinical guidance can be established.
He L, Zhu W, Liu Y, Huang Y. (2026). Stent-assisted coiling for ruptured anterior choroidal artery aneurysms: A retrospective observational study evaluating safety, efficacy, and antiplatelet strategies.. Medicine. https://doi.org/10.1097/MD.0000000000050421