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middle_cerebral_artery_aneurysm_endovascular_treatment

Middle cerebral artery aneurysm endovascular treatment

The endovascular treatment of middle cerebral artery aneurysm has been controversial due to the frequency of complex anatomy and relative ease of clipping in this location.

Case series

2016

From October 2011 to October 2015, 67 patients with 71 ruptured middle cerebral artery aneurysms received endovascular coiling in Yijishan Hospital, Wannan Medical College , Wuhu , Anhui Province , P.R. China.

Of all the 71 aneurysms (67 patients), 42 were treated by coil embolization merely, 27 by stent-assisted coiling and 2 unruptured aneurysms in patients with bilateral middle cerebral artery aneurysms without receiving treatment. Complete occlusion was achieved in 82.6% (57/69) of all the procedures. Each of incomplete and partial occlusion rate were 8.7% (6/69). Intraoperative rupture of aneurysms occurred in 2 procedures (2.9%). Thrombogenesis occurred in 8 procedures (11.6%). Brain infarction occurred in 8 patients (11.9%). Postoperative rebleeding occurred in 7 patients (10.4%). Sixty-three patients were followed at a mean follow-up of 8.24±7.16 months. The mortality and good outcome rate were 3.2% and 90.5%. Aneurysm recurrence occurred in 6 (13.3%) of the 45 aneurysms at a mean follow-up of 8.44±7.83 months.

Endovascular coiling is effective for patients with ruptured middle cerebral artery aneurysms. Individualized treatment should be assessed by experienced specialist. It is essential to perform randomized large trials to confirm the efficiency of endovascular coiling 1).

2014

The neurointerventional database at Division of Interventional Neuroradiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, MN., was reviewed for all endovascular treatments of MCA aneurysms. Demographics, aneurysm characteristics, treatment modality, intraprocedural hemorrhage and thromboembolic events, 30-day neurological events, and follow-up angiographic studies were recorded.

From December 1996 to April 2013, 292 patients underwent endovascular treatment of 346 MCA aneurysms. Of these, 341 were successfully completed (98.6%). Balloon neck remodeling was used in 230 procedures (66.5%). 95 procedures were for ruptured aneurysms (27.4%). The rate of intraprocedural hemorrhage was 2.6% (9 of 346). The overall rate of intraprocedural thromboembolic events was 13.6% (47 of 346), significantly more common in patients with acute subarachnoid hemorrhage (SAH, 27.4%, p < .001). The 30-day major (modified Rankin score > 2) neurological event rate was 2.9% (10 of 346), significantly more common in patients with SAH (8.4%) compared to those without (0.8%, p < .001). The rate of complete or near-complete aneurysm occlusion at ≥ 6 months was 90.6% and 91.8% at ≥ 2 years, with an average of 24 months follow-up available for 247 procedures.

Endovascular treatment of MCA aneurysms can be safe and effective. However, it is associated with a high asymptomatic thromboembolic event rate that is more frequent in the setting of acute SAH 2).

1)
Zhao X, Li Z, Fang X, Liu J, Wu D, Lai N. Treatment of ruptured middle cerebral artery aneurysms by endovascular approach: a single-center experience. Int J Neurosci. 2016 May 17:1-17. [Epub ahead of print] PubMed PMID: 27189026.
2)
Kadkhodayan Y, Delgado Almandoz JE, Fease JL, Scholz JM, Blem AM, Tran K, Crandall BM, Tubman DE. Endovascular Treatment of 346 MCA Aneurysms: Results of a 16-year Single Center Experience. Neurosurgery. 2014 Sep 24. [Epub ahead of print] PubMed PMID: 25255254.
middle_cerebral_artery_aneurysm_endovascular_treatment.txt · Last modified: 2016/05/21 07:59 (external edit)