Endovascular Treatment of Middle Cerebral Artery Aneurysms as First Option: A Single Center Experience of 92 Aneurysms

Quadros, Ricardo Souza; Gallas, Sophie; Noudel, R.; Rousseaux, P; Piérot, Laurent

doi:10.3174/ajnr.a0595

Cited by 70 publications

(66 citation statements)

References 22 publications

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“…Prat and Galeano [13] described 12 patients with a significant intracranial hematoma due to an MCA aneurysm that presented with WFNS grade 4 or 5, of which only five patients had a good or moderate outcome. The literature search also revealed a recent publication by Quadros et al [14] on the coiling of MCA aneurysms in 55 patients. They concluded that coiling was effective in preventing a rerupture of the symptomatic aneurysm (mean follow-up 14 months); however, with a total occlusion of the ruptured MCA aneurysm in merely 42% of their cases.…”

Section: Resultsmentioning

confidence: 93%

Surgical clipping as the preferred treatment for aneurysms of the middle cerebral artery

et al. 2011

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Objective In recent years the endovascular treatment of intracranial aneurysms (coiling) has progressively gained recognition, particularly after the publication of the International Subarachnoid Aneurysm Trial (ISAT) in 2002. Despite the fact that in ISAT middle cerebral artery (MCA) aneurysms were clearly underrepresented, the study is often used as an argument to favor coiling above surgery in MCA aneurysms. Taken into account that MCA aneurysms are very well accessible for surgery, a contemporary assessment of the benefits of a preferred surgical strategy for MCA aneurysms was performed in a tertiary neurovascular referral center. Methods A prospectively kept single-center database of 151 consecutive patients with an MCA aneurysm was reviewed over a 6-year period (2001)(2002)(2003)(2004)(2005)(2006). Long-term follow-up after surgical treatment of a ruptured MCA aneurysm was obtained in 74 out of 77 (96%) patients. The outcome was compared with relevant series in the literature.Results After a mean follow-up of 4.7 years, 59 out of 74 surgically treated patients (80%) with a ruptured MCA aneurysm had a good outcome (mRankin 0-2). All patients with an unruptured MCA aneurysm also had a good outcome after clipping. This is well-matched with the findings of the literature search, and competitive with the endovascular results.Conclusion Surgical clipping is recommended as the principal treatment strategy for MCA aneurysms. This is not only ethically defendable in view of the surgical results but also in line with a strategy to maintain surgical experience within centralized neurovascular centers.

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Section: Resultsmentioning

confidence: 93%

Surgical clipping as the preferred treatment for aneurysms of the middle cerebral artery

et al. 2011

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“…2,3,6,17) Complications related to the endovascular technique occurred in 13 (25.5%) of 51 patients with MCA aneurysms, comprising 3 ruptures and 10 thromboembolisms. 21) Only one intraprocedural rupture and one thromboembolic stroke occurred during the procedure in 30 patients with endovascularly treated MCA aneurysms. 7) In the present study, the rates of intraprocedural aneurysm perforation and thromboembolic events were 1.8% and 2.7%, respectively, rather better than previously reported rates.…”

Section: Discussionmentioning

confidence: 94%

“…Complete occlusion was achieved in 41.8%, residual neck in 43.6%, and residual aneurysm in 14.6%. 21) Embolization of 30 MCA aneurysms resulted in 80% complete occlusion and 20% partial occlusion. 7) Complete occlusion was achieved in 33 (86.8%) of 38 MCA aneurysms that were primarily selected for coil embolization.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment With Bare Platinum Coils for Middle Cerebral Artery Aneurysms

Oishi

Yoshida

Shimizu

et al. 2009

Neurol. Med. Chir.(Tokyo)

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Middle cerebral artery (MCA) aneurysms often have unfavorable anatomical characteristics preventing successful endovascular occlusion. We reviewed the outcomes of our series of endosaccular embolization of MCA aneurysms using bare platinum coils, angiographic images, and medical records. Immediate and follow-up angiographic results were categorized as complete occlusion, residual neck, and residual flow. Follow-up angiographic changes were categorized as unchanged, minor or major recurrence, and progressive thrombosis. Between December 2001 and August 2007, 112 patients with 113 MCA aneurysms underwent endovascular treatment, of whom 60 presented with subarachnoid hemorrhage (SAH) due to MCA aneurysm rupture. Immediate angiographic outcomes for 103 aneurysms revealed complete occlusion in 64, residual neck in 21, residual flow in 18, and failed embolization in 10. Follow-up angiography of 70 aneurysms demonstrated 41 unchanged, 10 minor recurrences, 12 major recurrences, 7 progressive thromboses, and no bleeding of coil embolized aneurysms. Outcomes of 58 SAH patients treated endovascularly revealed 45 good recovery and moderate disability, 10 severe disability or persistent vegetative state, and 3 deaths. Forty-four of the 45 patients with unruptured aneurysms treated endovascularly had no changes in their neurological status. One of 5 patients with complications had permanent morbidity. For patients with MCA aneurysms suitable for endovascular surgery, bare platinum coil embolization can be performed with acceptable low morbidity and mortality rates, with a lower risk of postprocedural aneurysmal bleeding.

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“…Middle cerebral artery aneurysms are also now frequently treated by an endovascular approach, with the use of a balloon or intracranial stent. 15 Nevertheless, only ruptured aneurysms with an intracerebral hematoma still undergo surgery to evacuate the hematoma and clip the aneurysm at the same time.…”

Section: Discussionmentioning

confidence: 99%

“…3 Some articles have been published pertaining to the stability of occlusions treated with detachable coils and the efficacy of providing protection against growth or regrowth of the aneurysm and consequent bleeding. [4][5][6][7][8][9][10][11][12][13][14][15][16] Long-term follow-up and the rate of recanalization due to coil compaction, typically caused by unfavorable morphologic characteristics such as lesion and neck size, remain a disadvantage compared with surgical treatment.…”

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confidence: 99%

Long-Term Follow-Up of 1036 Cerebral Aneurysms Treated by Bare Coils: A Multicentric Cohort Treated between 1998 and 2003

Gallas

Januel²,

Pasco³

et al. 2009

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:The endovascular treatment (EVT) of cerebral aneurysms has experienced a revolution since 1991 with the introduction of platinum coil technology. During the past 10 years, there has been significant study of the feasibility of this technique, and clinical results of EVT have been published. The long-term durability of Guglielmi detachable coil (GDC) embolization of cerebral aneurysms still remains unknown. The purpose of this study was to evaluate the stability of anatomic occlusion of aneurysms and to assess the rate of recanalization and retreatment of these aneurysms.

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Endovascular Treatment of Middle Cerebral Artery Aneurysms as First Option: A Single Center Experience of 92 Aneurysms

Abstract: BACKGROUND AND PURPOSE:We conducted a retrospective evaluation of the results of endovascular treatment (EVT) of middle cerebral artery aneurysms (MCAAs) in a center where embolization is the first treatment option considered.

Cited by 70 publications

References 22 publications

Surgical clipping as the preferred treatment for aneurysms of the middle cerebral artery

Surgical clipping as the preferred treatment for aneurysms of the middle cerebral artery

Endovascular Treatment With Bare Platinum Coils for Middle Cerebral Artery Aneurysms

Long-Term Follow-Up of 1036 Cerebral Aneurysms Treated by Bare Coils: A Multicentric Cohort Treated between 1998 and 2003

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