376 Ruptured ACA Aneurysms Yield Higher Mortality in Comparison to Patients With Ruptured Anterior Communicating Artery Aneurysms

INTRODUCTION: While aneurysms of the anterior communicating artery (AComm) are common, aneurysms of other anterior cerebral artery segments (A1 or distal ACA segments) are rare and inadequately studied. METHODS: The Cerebrovascular (CV) module of the Quality Outcomes Database (QOD) was queried to identify patients who underwent surgical treatment for aneurysms across 29 sites. Surgical outcomes, post-operative complications and patient reported outcomes were compared between unruptured and ruptured ACA and AComm aneurysms. Propensity score matching (PSM) of known confounders was performed utilizing a 1:4 ratio. The primary outcome was 30-day mortality. RESULTS: A total of 678 patients underwent treatment. 564 (83.2%) had an AComm aneurysm and 114 (16.8%) had an ACA aneurysm. On presentation, 282 AComm (50.4%) and 58 ACA (50.8%) aneurysms were ruptured. Within the unruptured matched cohort, there was no significant difference in any outcome variables including 30-day mortality. However, among the matched ruptured group, ACA aneurysms were associated with significantly higher rates of elevated post-operative intracranial pressure, reintubation, and pulmonary embolism. 30-day mortality rates were significantly higher among treated ruptured ACA aneurysms compared to AComm aneurysms (15.6% vs. 6.1%, p=0.04). Even after adjusting for post-operative complications, patients who presented with a ruptured ACA aneurysm had higher odds of mortality at 30 days when compared to those with a ruptured AComm aneurysm (OR: 3.30, 95% CI: 1.06-9.99). CONCLUSIONS: Patients presenting with ruptured ACA (A1 and distal ACA) aneurysms have significantly higher odds of 30-day mortality when compared to patients presenting with ruptured AComm aneurysms. Similar outcomes were observed following the treatment of unruptured ACA aneurysms in comparison to AComm aneurysms.