Endovascular Treatment With Bare Platinum Coils for Middle Cerebral Artery Aneurysms

Abstract

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.

Stent-Assisted Coiling of Complex Middle Cerebral Artery Aneurysms: Initial and Midterm Results

“…However, low morbidity-mortality (5.4%-12.4%) and aneurysm-recurrence rates (9.5%-10.5%) were observed at mid-and long-term in recent EVT series by using a simple coiling or balloon-remodeling technique. [10][11][12]21,30 In our institution, 1492 aneurysms were treated by EVT, including 234 MCA aneurysms (15.7%) with a high proportion of complex anatomy cases. From our previous experience, we considered that the complex anatomy of MCA aneurysms remains a challenge in EVT, and we hypothesized that the improvement of embolization techniques such as stent-assisted coiling could enhance feasibility, safety, and efficacy of EVT of MCA aneurysms.…”

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.…”

“…46 The thromboembolic rate was 6%, with permanent morbidity and mortality rate relating to this at 3%. This rate is lower than in many large endovascular series [10][11][12][13][14] and in prospective series 45,46 that demonstrate thromboembolism complicating 7%-19.6%. We attributed this finding, at least in part, to the routine use of intravenous aspirin and low use of adjunctive devices, particularly stents.…”

“…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.…”