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

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...

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Bibliographic Details
Published in:Acta neurochirurgica 2013-04, Vol.155 (4), p.559-568
Main Authors: Abla, Adib A., Jahshan, Shady, Kan, Peter, Mokin, Maxim, Dumont, Travis M., Eller, Jorge L., Snyder, Kenneth V., Hopkins, L. Nelson, Siddiqui, Adnan H., Levy, Elad I.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Aneurysm
Cardiovascular system
Clinical Article - Neurosurgical Techniques
Coiling
Endovascular Procedures
Female
Hospitals
Humans
Interventional Radiology
Intracranial Aneurysm - surgery
Male
Medicine
Medicine & Public Health
Middle Aged
Middle Cerebral Artery - surgery
Minimally Invasive Surgery
Neck
Neurology
Neuroradiology
Neurosurgery
Postoperative Complications - prevention & control
Saccule
subarachnoid hemorrhage
Subarachnoid Hemorrhage - surgery
Surgical Instruments
Surgical Orthopedics
Treatment Outcome
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Summary: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  
ISSN:0001-6268
0942-0940
DOI:10.1007/s00701-012-1594-8