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A shift from open to endovascular repair in the treatment of ruptured middle cerebral artery aneurysms: a single institution experience

  • Interventional Neuroradiology
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Abstract

Purpose

Middle cerebral aneurysms were underrepresented in the two largest trials (BRAT and ISAT) for the treatment of ruptured intracranial aneurysms. Recent institutional series addressing the choice between endovascular or open repair for this subset of aneurysms are few and have not yielded a definitive conclusion. We compare clinical outcomes of patients presenting with acute subarachnoid hemorrhage from ruptured middle cerebral artery aneurysms undergoing either open or endovascular repair.

Methods

We conducted a retrospective review of 138 consecutive patients with ruptured middle cerebral artery aneurysms admitted into our institution from January 2008 to March 2019 to compare endovascular and open surgical outcomes.

Results

Of the ruptured middle cerebral artery aneurysms, 57 underwent endovascular repair while 81 were treated with open surgery. Over the study period, there was a notable shift in practice toward more frequent endovascular treatment of ruptured MCA aneurysms (31% in 2008 vs. 91% in 2018). At discharge (49.1% vs 29.6%; p = .002) and at 6 months (84.3% vs 58.6%; p = 0.003), patients who underwent endovascular repair had a higher proportion of patients with good clinical outcomes (mRS 0–2) compared to those undergoing open surgery. Long-term follow-up data (endovascular 54.9 ± 37.9 months vs clipping 18.6 ± 13.4 months) showed no difference in rebleeding (1.8% vs 3.7%, p = 0.642) and retreatment (5.3% vs 3.7%, p = 0.691) in both groups.

Conclusion

Our series suggests equipoise in the treatment of ruptured middle cerebral artery aneurysms and demonstrates endovascular repair as a potentially feasible treatment strategy. Future randomized trials could clarify the roles of these treatment modalities.

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Data Availability

Data is available upon reasonable request from the corresponding author.

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Authors and Affiliations

  1. Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael’s Hospital, University of Toronto, Toronto, Canada

    Jose Danilo Bengzon Diestro, Yangmei Li, Kislay Kishore, Walter Montanera, Dipanka Sarma, Thomas R. Marotta, Julian Spears & Aditya Bharatha

  2. Department of Surgery, Division of Neurosurgery, Department of Surgery, St. Michael’s Hospital, University of Toronto, Toronto, Canada

    Abdelsimar T. Omar II, Dipanka Sarma, Thomas R. Marotta, Julian Spears & Aditya Bharatha

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  1. Jose Danilo Bengzon Diestro
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  2. Yangmei Li
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Correspondence to Jose Danilo Bengzon Diestro.

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Conflict of interest

JBD, honoraria from Medtronic. Travel grant from Microvention, TRM, principal of eVasc neurovascular.

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The institutional research ethics board reviewed and approved the study (SMH REB 16–350) and informed consent was waived.

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Diestro, J.D.B., Li, Y., Kishore, K. et al. A shift from open to endovascular repair in the treatment of ruptured middle cerebral artery aneurysms: a single institution experience. Neuroradiology 65, 1353–1361 (2023). https://doi.org/10.1007/s00234-023-03195-w

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