Endovascular Treatment of Unruptured MCA Bifurcation Aneurysms Regardless of Aneurysm Morphology: Short- and Long-Term Follow-Up

Abstract

BACKGROUND AND PURPOSE: The optimal treatment of unruptured middle cerebral aneurysms is still under debate. Although today almost any aneurysm can be treated endovascularly, there is a lack of data comparing endovascular and microsurgical repair of MCA aneurysms. The aim of our analysis is to provide data on the efficacy, clinical outcome, complications and re-treatment rates of endovascular treatment of this subtype of aneurysms. MATERIALS AND METHODS: Between May 2008 and July 2017, endovascular treatment of 1184 aneurysms in 827 patients was performed in our department. Twenty-four percent of these aneurysms were located at the MCA, and 150 unruptured MCA bifurcation aneurysms treated with coiling, stent-assisted-coiling, or endovascular flow diverter (WEB device) were identified for this retrospective data analysis. Ninety-six percent of all aneurysms, ruptured and unruptured, were treated by an endovascular approach, which yields a low selection bias for aneurysms suitable for endovascular treatment. Follow-up examinations were performed after 12 and 36 months and then every 1-3 years after embolization. Procedures were analyzed for periprocedural complications, outcome, and retreatment rate of the WEB (n ϭ 38) and coiling with (n ϭ 45) or without stent assistance (n ϭ 67). RESULTS: The procedure-associated good clinical outcome (mRS Ϲ 2) was 89.9%, and the mortality rate was 2.7%. Short-term follow-up good clinical outcome/mortality rates were 91.3%/0.7%. At discharge, 137 patients had an mRS of 0-2 (91.3%) and 13 had an mRS of 3-6 (8.7%). The retreatment rate was significantly higher in the WEB group (21.1%) compared with the coiling group with (5.9%) or without (2.2%) stent placement (P Ͻ .05). CONCLUSIONS: Regardless of the architecture of MCA bifurcation aneurysms, the endovascular treatment can be performed with low morbidity/mortality rates. The higher retreatment rate in the WEB group correlates with the learning curve in choosing the right device size.

Two-Center Experience in the Endovascular Treatment of Intracranial Aneurysms Using the Woven EndoBridge 17 Device Including Midterm Follow-Up Results: A Retrospective Analysis

“…The retreatment rate in our series was 2.4%, which is relevantly lower than the rates of 12.3% and 21.1% reported in other series with the WEB device. 17,18 One reason can be found in the increasing experience with the WEB device (learning curve), resulting in a more appropriate initial size selection with a lower retreatment rate as described in the literature. 18,19 Another reason might be found in the smaller aneurysm size in this series and the comparatively short follow-up period.…”

“…17,18 One reason can be found in the increasing experience with the WEB device (learning curve), resulting in a more appropriate initial size selection with a lower retreatment rate as described in the literature. 18,19 Another reason might be found in the smaller aneurysm size in this series and the comparatively short follow-up period. A comparative analysis of all aneurysms treated with WEB 21 and WEB 17 with longer follow-up data that is currently being conducted at our institution will help to identify the factors influencing a stable long-term occlusion.…”

The use of single low-profile visualized intraluminal support stent-assisted coiling in the treatment of middle cerebral artery bifurcation unruptured wide-necked aneurysm

“…1 Hagen et al. 8 reported 67 unruptured MCA bifurcation aneurysms treated with stent-assisted embolization, including the Neuroform (Stryker, USA) and LVIS Jr stents, with a 7.4% perioperative complication rate and a good outcome rate of 86.6% at discharge. Zhou et al.…”

Stent-Assisted Coiling of Unruptured MCA Aneurysms Using the LVIS Jr. Device: A Multicenter Registry

“…To the best of our knowledge, we have reported the largest series of unruptured MCA aneurysms treated with the stent-assisted coiling. Several authors have reported on the safety and efficacy of the stent-assisted coiling of MCA aneurysms with the use of older generation neurovascular stents [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. In a large study of 100 MCA aneurysms treated with the stent-assisted coiling by Johnson et al, the technical success rate of stent deployment was 100%.…”

“…There was no significant difference in complication rates between MCA aneurysms treated with different endovascular techniques. The retreatment rate of the aneurysms treated with the stent-assisted coiling in this study was 5.9% [ 17 ].…”