Results of endovascular treatment of middle cerebral artery aneurysms after first giving consideration to clipping
- First Online:
- 515 Downloads
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.
Review of prospectively maintained intracranial aneurysm database.
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).
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.
KeywordsCoil embolization Clipping Endovascular technique Intracranial aneurysm Middle cerebral artery
Hunt & Hess
Internal carotid artery
International Subarachnoid Aneurysm Trial
Middle cerebral artery
Modified Rankin scale
World Federation of Neurosurgical Societies
- 2.Bracard S, Abdel-Kerim A, Thuillier L, Klein O, Anxionnat R, Finitsis S, Lebedinsky A, de Freitas CM, Pinheiro N, de Andrade GC, Picard L (2010) Endovascular coil occlusion of 152 middle cerebral artery aneurysms: initial and midterm angiographic and clinical results. J Neurosurg 112:703–708PubMedCrossRefGoogle Scholar
- 9.Kan P, Jahshan S, Yashar P, Orion D, Webb S, Siddiqui AH, Hopkins LN, Levy EI (2012) Feasibility, safety, and periprocedural complications associated with endovascular treatment of selected ruptured aneurysms under conscious sedation and local anesthesia. Neurosurgery. doi:10.1227/NEU.0b013e31827b9183
- 12.Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P (2005) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366:809–817PubMedCrossRefGoogle Scholar