Endovascular Treatment of Middle Cerebral Artery Aneurysms With Detachable Coils

Abstract

In this series, endovascular coil embolization of MCA aneurysms has morbidity and mortality rates comparable to those of conventional surgical clipping. Combined treatment of endovascular and bypass surgery can successfully treat large or giant complex fusiform MCA aneurysms.

Endovascular Treatment of Middle Cerebral Artery Aneurysms for 120 Nonselected Patients: A Prospective Cohort Study

“…Of note, we used the number of patients involved as our denominator to figure out morbidity-mortality. The morbidity and mortality rates in our series are similar to those in previous EVT studies in selected cases such as the results by Suzuki et al 8 and Vendrell et al 9 Meanwhile, morbidity-mortality of surgical clipping of MCA aneurysms is largely variable, ranging from 1.8 -13.6%. [3][4][5]15 Recently the UCSF neurosurgical group reported a 5.3% mortality rate and a 4.6% permanent morbidity rate after managing 631 MCA aneurysms (51.9% ruptured aneurysms) in 543 patients.…”

“…6 However, most of these series were highly focused on selected patients. [7][8][9][10] To date, with the advent of new endovascular tools such as balloons and stents designed specifically for the intracranial circulation, MCA aneurysms can be managed by means of the endovascular approach. However, the safety and efficacy of EVT for all patients are not well known yet.…”

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

“…Favorable clinical outcomes (mRS, 0 -2 and GOS, 5) in other large series of ruptured MCA aneurysms comprising at least 50 patients treated with EVC, are within the 67%-85% range. [10][11][12][13][14] In the present study, the largest published single-center experience to date, patients with consecutive ruptured MCA aneurysms achieved good outcome (GOS, 5) in 70.3% and favorable outcome (GOS, 4 and 5) in nearly 80%, with the proportion of favorable presenting clinical grade patients (WFNS, 1-2) being 72%. We were able to directly compare the results of our present study to a large audit of ruptured aneurysms at all locations treated through EVC at our institution with similar distribution of clinical grade.…”

“…In other endovascular series of at least 50 patients, re-treatment rates varied from 2.4%-13.9%. [10][11][12][13][14]32 It is well recognized that the decision to re-treat is highly variable. 37 Our cohort had no additional morbidity or mortality relating to the additional procedures, and in line with previous findings, 38,39 the risk for further coil embolization did not negate the advantage of the initial embolization.…”

“…The perforation rate lies within the range of previously published studies that have demonstrated procedural perforation complicating 1%-8.5% of MCA aneurysm treatments. [10][11][12][13][14]32 In 2 large prospective series of unruptured aneurysms (ATENA) 45 and ruptured aneurysms (CLARITY) treated by endovascular means, the perforation rate for MCA aneurysms was 4.1% and 8.5%, respectively. We have previously suggested that the rate of aneurysmal perforation may be higher at the MCA location 15 ; we demonstrated that MCA aneurysms accounted for 13% of cases but 24% of all intraprocedural ruptures.…”