Coiling Versus Microsurgical Clipping in the Treatment of Unruptured Middle Cerebral Artery Aneurysms: A Meta-Analysis

Alreshidi, Meshal; Coté, David J.; Dasenbrock, Hormuzdiyar H.; Acosta, Michael; Can, Anil; Doucette, Joanne; Simjian, Thomas; Hulou, M. Maher; Wheeler, Lee Adam; Huang, Kevin T.; Zaidi, Hasan A.; Du, Rose; Aziz-Sultan, Mohammad Ali; Mekary, Rania A.; Smith, Timothy R.

doi:10.1093/neuros/nyx623

Cited by 47 publications

(21 citation statements)

References 49 publications

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“…The Cochrane review by Lindgren et al on this topic only included four RCTs and the results principally favored those of the ISAT, due to its dominance in patient numbers [63]. There have been other published meta-analyses comparing the two treatment modalities, which include data from observational studies, specifically in the treatment of patients with unruptured MCA IAs [3], and patients with oculomotor nerve palsies induced by posterior communicating artery IAs [143]. We summarize in Table 3 the systematic reviews and meta-analysis which are most up-to-date or comprising largest dataset, comparing outcomes (efficacy, complications rates, morbidity, mortality, and economic status) of microsurgical and endovascular approaches for IAs by type, location, and rupture status.…”

Section: Endovascular Therapy Post-microsurgical Treatmentmentioning

confidence: 99%

The evolution of intracranial aneurysm treatment techniques and future directions

et al. 2021

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Treatment techniques and management guidelines for intracranial aneurysms (IAs) have been continually developing and this rapid development has altered treatment decision-making for clinicians. IAs are treated in one of two ways: surgical treatments such as microsurgical clipping with or without bypass techniques, and endovascular methods such as coiling, balloon- or stent-assisted coiling, or intravascular flow diversion and intrasaccular flow disruption. In certain cases, a single approach may be inadequate in completely resolving the IA and successful treatment requires a combination of microsurgical and endovascular techniques, such as in complex aneurysms. The treatment option should be considered based on factors such as age; past medical history; comorbidities; patient preference; aneurysm characteristics such as location, morphology, and size; and finally the operator’s experience. The purpose of this review is to provide practicing neurosurgeons with a summary of the techniques available, and to aid decision-making by highlighting ideal or less ideal cases for a given technique. Next, we illustrate the evolution of techniques to overcome the shortfalls of preceding techniques. At the outset, we emphasize that this decision-making process is dynamic and will be directed by current best scientific evidence, and future technological advances.

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Section: Endovascular Therapy Post-microsurgical Treatmentmentioning

confidence: 99%

The evolution of intracranial aneurysm treatment techniques and future directions

et al. 2021

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“…Middle cerebral artery (MCA) aneurysms are primarily treated with either microsurgical clipping or endovascular coiling. 1 However, fusiform aneurysms, recurrent aneurysms, or aneurysms with distal branches arising from the aneurysm sac remain difficult to treat. 2 Morbidity or insufficient occlusion is not uncommon after treatment of these types of aneurysms.…”

Section: Introductionmentioning

confidence: 99%

Endovascular treatment of complex middle cerebral artery aneurysms using TuBridge flow diverters

Yang

Luo

et al. 2020

Interv Neuroradiol

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Background The safety and efficacy of the TuBridge flow diverter in treating middle cerebral artery aneurysms remains unknown. In this study, we report our preliminary experience treating complex middle cerebral artery aneurysms using the TuBridge flow diverter. Methods A prospectively maintained database of intracranial aneurysms treated with the TuBridge flow diverter was retrospectively reviewed, and patients with middle cerebral artery aneurysms were included in this study. Demographics, aneurysm features, complications, and clinical and angiographic outcomes were assessed. Evaluation of the angiographic results included occlusion grade of aneurysm (O’Kelly–Marotta grading scale), patency of jailed branch(es), and in-stent stenosis. Results Eight patients with eight middle cerebral artery aneurysms were included in this study. The mean aneurysm size was 11.8 ± 6.8 mm. There were no procedure-related complications and there was no morbidity or mortality at a mean follow-up of 11.3 ± 3.6 months. All patients had follow-up angiograms at a mean of 7.5 ± 4.0 months after surgery. Of the eight patients, there was 1 (12.5%) O’Kelly–Marotta grading scale A, 3 (37.5%) O’Kelly–Marotta grading scale B, 1 (12.5%) O’Kelly–Marotta grading scale C, and 3 (37.5%) O’Kelly–Marotta grading scale D. Of the seven patients with jailed branch, the blood flow of jailed branch was unchanged in 4 (57.1%), decreased in 2 (28.6%), and occluded in 1 (14.3%). In-stent stenosis was mild in 2 (25%) patients and moderate in 1 (12.5%) patient. Conclusion Midterm results suggest that endovascular treatment of middle cerebral artery aneurysms using the TuBridge flow diverter is safe and associated with good outcomes. The TuBridge flow diverter may be an option for complex middle cerebral artery aneurysms that are difficult to treat with either clipping or coiling.

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“…For the last century, the gold standard was microsurgical clipping. However, in recent years, endovascular coiling has become more prevalent in clinics (Alreshidi et al, 2018;Deruty et al, 1996;Raftopoulos et al, 2003;Regli et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

Anterior communicating artery aneurysm rupture and functional outcome in short-term: clipping versus coiling

Bäcker

Shoap

Vajda

et al. 2020

Journal of Integrative Neuroscience

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Our research aims to assess the change in the grade of responsiveness using the Hunt and Hess score as well as the modified ranking scale in patients suffering from anterior communicating artery rupture. We retrospectively analyzed data from 11-patients who suffered from an anterior communicating artery aneurysm rupture that caused a subarachnoid hemorrhage. Severity was assessed using the Hunt and Hess scale grade and modified ranking scale. Anterior communicating artery rupture caused a subarachnoid hemorrhage in 40.81% of all aneurysm ruptures that took place at the Circle of Willis. Unfortunately, 4-patients deceased (3.4%) at a median age of 52-years (range 34-75-years), three of which deceased after coiling and one after clipping. In 71-patients (61.2%) endovascular coiling was performed-33-males and 38-females-and in the remaining 45-cases, (38.8%) clipping was indicated-24-males and 21-females. Overall, the pre-interventional median Hunt and Hess scale was 2, which remained after the intervention. When relating the outcome score to the intervention performed, we found that the Hunt and Hess scale score was 3 before coiling and 2 before clipping, whereas afterward, there was a slight increase to 2 and 2, respectively. The modified ranking scale was 2 after clipping, respectively, coiling (P = 0.218). No significant differences were observed between the different groups. Our results show that clipping is as effective as coiling in terms of the Hunt and Hess scale and the rate of mortality in the short-term.

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Coiling Versus Microsurgical Clipping in the Treatment of Unruptured Middle Cerebral Artery Aneurysms: A Meta-Analysis

Abstract: This updated meta-analysis demonstrates that surgical clipping for unruptured MCAA remains highly safe and efficacious. Endovascular treatment for unruptured MCAAs continues to improve in efficacy and safety; yet, it results in lower rates of occlusion.

Cited by 47 publications

References 49 publications

The evolution of intracranial aneurysm treatment techniques and future directions

The evolution of intracranial aneurysm treatment techniques and future directions

Endovascular treatment of complex middle cerebral artery aneurysms using TuBridge flow diverters

Anterior communicating artery aneurysm rupture and functional outcome in short-term: clipping versus coiling

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