Endovascular Treatment of 300 Consecutive Middle Cerebral Artery Aneurysms: Clinical and Radiologic Outcomes

Mortimer, Alex; Bradley, Marcus; Mews, Peter; Molyneux, Andrew; Renowden, Shelley

doi:10.3174/ajnr.a3776

Cited by 38 publications

(38 citation statements)

References 52 publications

(79 reference statements)

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“…18,20,23 In our series, one-half of the 46 patients had IPH associated with aneurysm rupture, and 7 (14%) of them required a decompressive craniotomy. Notably, in the series of endovascularly treated ruptured MCA aneurysms by Mortimer et al, 14 8.2% (20 of 244) of patients underwent surgery for IPH evacuation or decompressive craniotomy after endovascular treatment of the aneurysm. They reported a good outcome (defined as a GOS score of 4) in 40% (n = 8) of the 20 patients and a 45% mortality rate (n = 9).…”

Section: Discussionmentioning

confidence: 99%

“…1,17 These results are at odds with the primary goal of ruptured aneurysm treatment, which is to prevent rerupture. Indeed, 3 patients in the Mortimer et al 14 series experienced rerupture after treatment, and all 3 patients died as a result.…”

Section: Discussionmentioning

confidence: 99%

“…13 As endovascular treatment strategies continue to evolve, reports are increasing about the treatment of ruptured MCA aneurysms with endovascular strategies. 4,6,9,10,12,14,16,17,27 In the largest series in the endovascular literature to date, Mortimer et al 14 Although some selection bias might be present in their series, Mortimer et al 14 noted that they practice a "coilfirst" policy at their institution and that only 51 patients with ruptured MCA aneurysms were treated with primary clipping during roughly the same period. Twenty-one of these patients were noted to have poor anatomy for endovascular treatment or had already undergone an unsuccessful attempt at coiling, whereas the remainder of those who underwent clipping did so because of surgeon preference or the lack of availability of an interventional neuroradiologist.…”

Section: Discussionmentioning

confidence: 99%

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Long-term results of middle cerebral artery aneurysm clipping in the Barrow Ruptured Aneurysm Trial

Mooney¹,

Simon²,

Brigeman³

et al. 2019

Journal of Neurosurgery

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OBJECTIVE A direct comparison of endovascular versus microsurgical treatment of ruptured middle cerebral artery (MCA) aneurysms in randomized trials is lacking. As endovascular treatment strategies continue to evolve, the number of reports of endovascular treatment of these lesions is increasing. Herein, the authors report a detailed post hoc analysis of ruptured MCA aneurysms treated by microsurgical clipping from the Barrow Ruptured Aneurysm Trial (BRAT). METHODS The cases of patients enrolled in the BRAT who underwent microsurgical clipping for a ruptured MCA aneurysm were reviewed. Characteristics of patients and their clinical outcomes and long-term angiographic results were analyzed. RESULTS Fifty patients underwent microsurgical clipping of a ruptured MCA aneurysm in the BRAT, including 21 who crossed over from the endovascular treatment arm. Four patients with nonsaccular (e.g., dissecting, fusiform, or blister) aneurysms were excluded, leaving 46 patients for analysis. Most (n = 32; 70%) patients presented with a Hunt and Hess grade II or III subarachnoid hemorrhage, with a high prevalence of intraparenchymal blood (n = 23; 50%), intraventricular blood (n = 21; 46%), or both. At the last follow-up (up to 6 years after treatment), clinical outcomes were good (modified Rankin Scale score 0-2) in 70% (n = 19) of 27 Hunt and Hess grades I-III patients and in 36% (n = 4) of 11 Hunt and Hess grade IV or V patients. There were no instances of rebleeding after the surgical clipping of aneurysms in this series at the time of last clinical follow-up. CONCLUSIONS Microsurgical clipping of ruptured MCA aneurysms has several advantages over endovascular treatment, including durability over time. The authors report detailed outcome data of patients with ruptured MCA aneurysms who underwent microsurgical clipping as part of a prospective, randomized trial. These results should be used for comparison with future endovascular and surgical series to ensure that the best results are being achieved for patients with ruptured MCA aneurysms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Long-term results of middle cerebral artery aneurysm clipping in the Barrow Ruptured Aneurysm Trial

Mooney¹,

Simon²,

Brigeman³

et al. 2019

Journal of Neurosurgery

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“…Analysis of a matched (aneurysm location, diameter, and neck size) cohort demonstrated not only an overall higher risk of recanalization in ruptured IA but also shorter period and higher degrees of recanalization and a higher percentage of retreatment when compared with unruptured IA [95]. It is increasingly recognized that the need of retreatment after GDC embolization are more common in ruptured than unruptured IA [20,38,64,71,72].…”

Section: The Fundamental Difference Between Ruptured and Unruptured Iamentioning

confidence: 99%

Recurrence of endovascularly and microsurgically treated intracranial aneurysms—review of the putative role of aneurysm wall biology

Marbacher

Niemelä²,

Hernesniemi³

et al. 2017

Neurosurg Rev

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Although endovascular therapy has been proven safe and has become in many centers the primary method of treatment for intracranial aneurysms, the long-term durability of endovascular embolization remains a concern; at least for some aneurysms despite initial good result. While healing after clipping relies on mechanical occlusion, restoration after endovascular occlusion mainly requires the induction of a biological response. Healing after embolization depends on the growth of new tissue over the thrombus formed by the embolization material, or alternatively, on the organization of thrombus into fibrous tissue. This review highlights the fundamental importance of aneurysm wall biology on the healing process and long-term occlusion after intracranial aneurysm (IA) treatment. It seems likely that the effect of luminal thrombus on the IA wall, as well as the IA wall condition at the time of thrombosis, determine if thrombus organizes into scar tissue (neointima formation by infiltration of cells originating from the IA wall) or if the wall undergoes continuous remodeling, which is primarily destructive (loss of mural cells). In the latter, intraluminal thrombus organization fails and the impaired healing increases the chance of recurrence. Mechanisms underlying IA reopening, the influence of intraluminal thrombosis on the IA wall, and clinical implications of the IA wall condition are discussed in detail, along with how knowledge of IA wall biology can offer new solutions for IA treatment and affect the patient selection for and follow-up after endovascular treatment.

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“…Their natural history, as well as the etiopathogenesis, do not remain completely elucidated. The incidence of a giant aneurysm is reported to be 6.1% [ 2 ]. There is still a controversial discussion if clipping or coiling MCA aneurysms are superior or better for the patient, and often there is no ideal solution.…”

Section: Introductionmentioning

confidence: 99%

Stent-assisted Embolization of a Giant Aneurysm of the Middle Cerebral Artery Using Small and Large Coils (Penumbra Coil 400)

Ordóñez-Rubiano

Von-Diemling

Cortes-Lozano

et al. 2016

Cureus

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Giant aneurysms have been treated with endovascular approaches like general, balloon-assisted and stent-assisted coiling, and flow diverter stent-assisted techniques. Few cases have been reported to be treated with both normal and large coils. Despite the mass effect, an adequate revascularization has been reported. An initial use of these coils is being reported in the current study. This is a case which has been successfully treated using a stent-assisted coiling with both small and large coils i.e., Penumbra Coil 400 (Penumbra, Inc., Alameda, California).

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Endovascular Treatment of 300 Consecutive Middle Cerebral Artery Aneurysms: Clinical and Radiologic Outcomes

Abstract: BACKGROUND AND PURPOSE:There is controversy as to the best mode of treating MCA aneurysms. We report the results of a large endovascular series of patients treated at our center.

Cited by 38 publications

References 52 publications

Long-term results of middle cerebral artery aneurysm clipping in the Barrow Ruptured Aneurysm Trial

Long-term results of middle cerebral artery aneurysm clipping in the Barrow Ruptured Aneurysm Trial

Recurrence of endovascularly and microsurgically treated intracranial aneurysms—review of the putative role of aneurysm wall biology

Stent-assisted Embolization of a Giant Aneurysm of the Middle Cerebral Artery Using Small and Large Coils (Penumbra Coil 400)

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