Acta Neurochirurgica

, Volume 155, Issue 4, pp 559–568

Results of endovascular treatment of middle cerebral artery aneurysms after first giving consideration to clipping

  • Adib A. Abla
  • Shady Jahshan
  • Peter Kan
  • Maxim Mokin
  • Travis M. Dumont
  • Jorge L. Eller
  • Kenneth V. Snyder
  • L. Nelson Hopkins
  • Adnan H. Siddiqui
  • Elad I. Levy
Clinical Article - Neurosurgical Techniques

DOI: 10.1007/s00701-012-1594-8

Cite this article as:
Abla, A.A., Jahshan, S., Kan, P. et al. Acta Neurochir (2013) 155: 559. doi:10.1007/s00701-012-1594-8

Abstract

Background

Middle cerebral artery (MCA) aneurysms are among the more challenging aneurysms for endovascular treatment. We report a contemporary 5-year experience with endovascular therapy for MCA aneurysms at a high-volume neurovascular center.

Methods

Review of prospectively maintained intracranial aneurysm database.

Results

Between 2005 and 2009, 148 patients underwent treatment of 149 MCA aneurysms at our hospital, of which 33 patients with 34 aneurysms underwent endovascular therapy. Among these 33 patients, 14 presented with subarachnoid hemorrhage. Eleven patients were treated with stent-assisted coiling, 1 with balloon-assisted coiling, and the remainder with coiling alone. Three patients required repeat endovascular treatment. There were 7 periprocedural complications, including intraprocedural aneurysm rupture resulting in death in 2 patients. Two patients died at later dates from remote aneurysm rehemorrhage. Average follow-up of remaining patients was 17.1 months radiographically, and 20.3 months clinically. Average modified Rankin scale (mRS) score at last follow up was 2.09, with 17 patients with mRS 0/1 and 5 patients with mRS 2. Fifteen patients showed evidence of radiographic residual at last follow up: 13 were simple neck residuals. Unruptured status and saccular aneurysms were associated with mRS 0/1 outcome (each p < 0.05).

Conclusions

At our hospital, MCA aneurysms are being treated with endovascular techniques, but in a minority of patients. Despite the rate of residual neck remnants, few retreatments were necessary and few rehemorrhages occurred. The periprocedural complication rate was not insignificant; therefore, in more recent years and at present, most MCA aneurysms are considered for clipping first at our center.

Keywords

Coil embolizationClippingEndovascular techniqueIntracranial aneurysmMiddle cerebral artery

Abbreviations

HH

Hunt & Hess

ICA

Internal carotid artery

ISAT

International Subarachnoid Aneurysm Trial

MCA

Middle cerebral artery

mRS

Modified Rankin scale

SAH

Subarachnoid hemorrhage

WFNS

World Federation of Neurosurgical Societies

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  • Adib A. Abla
    • 1
    • 3
  • Shady Jahshan
    • 1
    • 3
  • Peter Kan
    • 1
    • 3
  • Maxim Mokin
    • 1
    • 3
  • Travis M. Dumont
    • 1
    • 3
  • Jorge L. Eller
    • 1
    • 3
  • Kenneth V. Snyder
    • 1
    • 2
    • 3
  • L. Nelson Hopkins
    • 1
    • 2
    • 3
    • 4
  • Adnan H. Siddiqui
    • 1
    • 2
    • 3
  • Elad I. Levy
    • 1
    • 2
    • 3
    • 5
  1. 1.Department of Neurosurgery and Toshiba Stroke Research CenterUniversity at Buffalo, State University of New YorkBuffaloUSA
  2. 2.Department of RadiologyUniversity at Buffalo, State University of New YorkBuffaloUSA
  3. 3.Department of Neurosurgery, Gates Vascular Institute, Kaleida HealthBuffaloUSA
  4. 4.Jacobs InstituteBuffaloUSA
  5. 5.University at Buffalo NeurosurgeryBuffaloUSA