Objective: (1) To correlate three-dimensional angiographic anatomy with microsurgical strategies used for clipping of ruptured anterior communicating artery (Acom) aneurysms. (2) To analyze clinical, radiological, and surgical factors affecting outcome following Acom aneurysmal subarachnoid hemorrhage. Methods: This retrospective cohort study included 56 consecutive patients who underwent microsurgical clipping for ruptured Acom aneurysms over 3 years. Clinical records, radiological imaging, and operative videos were reviewed. Angiographic features, including A1 dominance, dome projection, and orientation of the Acom complex, were correlated with surgical approach and clipping strategy. Outcomes were assessed using the Glasgow Outcome Scale. Associations between selected variables and outcome were evaluated using univariate statistical analysis. Results: Unilateral A1 dominance was observed in 70% of patients and guided the side of the surgical approach. Superior dome projection was the most common configuration (59%), followed by anterior (18%), inferior (7%), and posterior (9%) projections, which determined the clipping corridor used. In approximately one-third of ruptured cases, the aneurysm was smaller than 5 mm. Increasing aneurysm size was associated with higher grades of subarachnoid hemorrhage. Neurological status at admission, assessed using modified World Federation of Neurosurgical Societies grading, showed a strong association with outcome. Delayed cerebral ischemia contributed to postoperative deterioration in a subset of patients. Conclusion: Detailed preoperative angiographic assessment is essential for planning microsurgical clipping of ruptured Acom aneurysms. Admission neurological status is a very important factor affecting the outcome following aneurysmal subarachnoid hemorrhage.
Narasimhan et al. (2026) studied this question.