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

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 embolization Clipping Endovascular technique Intracranial aneurysm Middle 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

References

  1. 1.
    Baltacioglu F, Cekirge S, Saatci I, Ozturk H, Arat A, Pamir N, Ozgen T (2002) Distal middle cerebral artery aneurysms. Endovascular treatment results with literature review. Interv Neuroradiol 8:399–407PubMedGoogle Scholar
  2. 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
  3. 3.
    Brinjikji W, Lanzino G, Cloft HJ, Rabinstein A, Kallmes DF (2011) Endovascular treatment of middle cerebral artery aneurysms: a systematic review and single-center series. Neurosurgery 68:397–402PubMedCrossRefGoogle Scholar
  4. 4.
    Doerfler A, Wanke I, Goericke SL, Wiedemayer H, Engelhorn T, Gizewski ER, Stolke D, Forsting M (2006) Endovascular treatment of middle cerebral artery aneurysms with electrolytically detachable coils. AJNR Am J Neuroradiol 27:513–520PubMedGoogle Scholar
  5. 5.
    Dorfer C, Gruber A, Standhardt H, Bavinzski G, Knosp E (2012) Management of residual and recurrent aneurysms after initial endovascular treatment. Neurosurgery 70:537–554. doi:10.1227/NEU.0b013e3182350da5 PubMedCrossRefGoogle Scholar
  6. 6.
    Guglielmi G, Vinuela F, Duckwiler G, Jahan R, Cotroneo E, Gigli R (2008) Endovascular treatment of middle cerebral artery aneurysms. Overall perioperative results. Apropos of 113 cases. Interv Neuroradiol 14:241–245PubMedGoogle Scholar
  7. 7.
    Horowitz M, Gupta R, Gologorsky Y, Jovin T, Genevro J, Levy E, Kassam A (2006) Clinical and anatomic outcomes after endovascular coiling of middle cerebral artery aneurysms: report on 30 treated aneurysms and review of the literature. Surg Neurol 66:167–171PubMedCrossRefGoogle Scholar
  8. 8.
    Iijima A, Piotin M, Mounayer C, Spelle L, Weill A, Moret J (2005) Endovascular treatment with coils of 149 middle cerebral artery berry aneurysms. Radiology 237:611–619PubMedCrossRefGoogle Scholar
  9. 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
  10. 10.
    Lubicz B, Graca J, Levivier M, Lefranc F, Dewitte O, Pirotte B, Brotchi J, Baleriaux D (2006) Endovascular treatment of middle cerebral artery aneurysms. Neurocrit Care 5:93–101PubMedCrossRefGoogle Scholar
  11. 11.
    McDougall CG, Spetzler RF, Zabramski JM, Partovi S, Hills NK, Nakaji P, Albuquerque FC (2012) The Barrow ruptured aneurysm trial. J Neurosurg 116:135–144PubMedCrossRefGoogle Scholar
  12. 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
  13. 13.
    Morgan MK, Mahattanakul W, Davidson A, Reid J (2010) Outcome for middle cerebral artery aneurysm surgery. Neurosurgery 67:755–761PubMedCrossRefGoogle Scholar
  14. 14.
    Ogilvy CS, Yang X, Jamil OA, Hauck EF, Hopkins LN, Siddiqui AH, Levy EI (2011) Neurointerventional procedures for unruptured intracranial aneurysms under procedural sedation and local anesthesia: a large-volume, single-center experience. J Neurosurg 114:120–128PubMedCrossRefGoogle Scholar
  15. 15.
    Oishi H, Yoshida K, Shimizu T, Yamamoto M, Horinaka N, Arai H (2009) Endovascular treatment with bare platinum coils for middle cerebral artery aneurysms. Neurol Med Chir (Tokyo) 49:287–293CrossRefGoogle Scholar
  16. 16.
    Quadros RS, Gallas S, Noudel R, Rousseaux P, Pierot L (2007) Endovascular treatment of middle cerebral artery aneurysms as first option: a single center experience of 92 aneurysms. AJNR Am J Neuroradiol 28:1567–1572PubMedCrossRefGoogle Scholar
  17. 17.
    Regli L, Dehdashti AR, Uske A, de Tribolet N (2002) Endovascular coiling compared with surgical clipping for the treatment of unruptured middle cerebral artery aneurysms: an update. Acta Neurochir Suppl 82:41–46PubMedGoogle Scholar
  18. 18.
    Regli L, Uske A, de Tribolet N (1999) Endovascular coil placement compared with surgical clipping for the treatment of unruptured middle cerebral artery aneurysms: a consecutive series. J Neurosurg 90:1025–1030PubMedCrossRefGoogle Scholar
  19. 19.
    Ryttlefors M, Enblad P, Kerr RS, Molyneux AJ (2008) International subarachnoid aneurysm trial of neurosurgical clipping versus endovascular coiling: subgroup analysis of 278 elderly patients. Stroke 39:2720–2726PubMedCrossRefGoogle Scholar
  20. 20.
    Suzuki S, Tateshima S, Jahan R, Duckwiler GR, Murayama Y, Gonzalez NR, Vinuela F (2009) Endovascular treatment of middle cerebral artery aneurysms with detachable coils: angiographic and clinical outcomes in 115 consecutive patients. Neurosurgery 64:876–889PubMedCrossRefGoogle Scholar
  21. 21.
    van Dijk JM, Groen RJ, Ter Laan M, Jeltema JR, Mooij JJ, Metzemaekers JD (2011) Surgical clipping as the preferred treatment for aneurysms of the middle cerebral artery. Acta Neurochir (Wien) 153:2111–2117CrossRefGoogle Scholar
  22. 22.
    Vendrell JF, Costalat V, Brunel H, Riquelme C, Bonafe A (2011) Stent-assisted coiling of complex middle cerebral artery aneurysms: initial and midterm results. AJNR Am J Neuroradiol 32:259–263PubMedCrossRefGoogle Scholar
  23. 23.
    Vendrell JF, Menjot N, Costalat V, Hoa D, Moritz J, Brunel H, Bonafe A (2009) Endovascular treatment of 174 middle cerebral artery aneurysms: clinical outcome and radiologic results at long-term follow-up. Radiology 253:191–198PubMedCrossRefGoogle Scholar
  24. 24.
    Zomorodi A, Bulsara KR, Friedman AH, Alexander MJ (2010) Combined microsurgical and endovascular treatment of a giant left middle cerebral artery aneurysm. J Neurointerv Surg 2:213–216PubMedCrossRefGoogle Scholar

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

Personalised recommendations