P177 Unruptured anterior communicating artery aneurysms: management strategy and results of a single-center experience

<h3>Introduction</h3> Although anterior communicating artery (AComA) unruptured intracranial aneurysms (UIAs) comprise one of the largest aneurysm subgroups, their complex adjacent neurovasculature and increased risk of rupture impede optimal management. <h3>Aim of Study</h3> In the present study, we analyzed the results of our diverse strategy in AComA UIAs with the additional goal of assessing the risk of treatment and the incidence of hemorrhage. <h3>Methods</h3> We analyzed 131 patients, of which each was assessed by a multidisciplinary neurovascular team and assigned to observation (45.8%), endovascular treatment (34.4%) or microsurgery (19.8%). <h3>Results</h3> Median aneurysm sizes were 3, 7.2 and 7.75 mm, respectively. In the observation group, four (7.1%) aneurysms (initially &lt;5 mm) grew over a median time of 63.5 months and were treated endovascularly. We found that fewer patients in the observation group were smokers (<i>p</i> = 0.021). The aneurysm size ratio was different between the combined treatment versus the observation group (<i>p</i> &lt; 0.0001). Noteworthily, there were no hemorrhages in the observational group. Mortality for all patients with available follow-up was 2.4% (3/124) and permanent morbidity was 1.6% (2/124) over a mean follow-up of 64.2 months. These compelling rates refer to a high-risk group with potentially devastating consequences in which we have decreased the annual risk of hemorrhage to 0.14% <h3>Conclusion</h3> Using diversified management of AComA UIAs, we have decreased the annual risk of SAH to 0.14% at the expense of 2.4% mortality and 1.6% permanent minor deficit rates. <h3>Disclosure of Interest</h3> no.