SUMMARY:We present the case of a patient with a fusiform aneurysm of the M1 segment of the middle cerebral artery (MCA) in which endovascular stent placement without coiling was performed. A 3.5-mm ϫ 25-mm LEO self-expanding stent was deployed along the fusiform aneurysm of the horizontal MCA M1 segment. Digital subtraction angiography showed progressive thrombosis at 6 months and complete thrombosis of the fusiform MCA aneurysm at 12 months.T he introduction of the Guglielmi detachable coil in 1991 [1][2] radically changed the approach to intracranial aneurysms, and endovascular treatment became a frequent choice for many ruptured intracranial aneurysms. Recently, new techniques and materials have widened the range of aneurysms susceptible to endovascular treatment. However, the management of fusiform intracranial aneurysms remains controversial. We present the case of a 52-year-old man with a fusiform aneurysm of the middle cerebral artery (MCA), who was successfully treated with the placement of a Leo stent. To our knowledge, this is the first fusiform MCA aneurysm successfully treated using the placement of a neurovascular dedicated stent.
Case ReportA 52-year-old man was referred to our hospital for a partially thrombosed fusiform large aneurysm of the M1 segment of the MCA. The aneurysm was diagnosed after the patient had undergone MR imaging at another institution because of acute-onset aphasia and right hemiparesis. The patient's medical and family history was unremarkable. MR imaging examination revealed a partially thrombosed MCA aneurysm and a subacute infarction in the left MCA territory (lenticulostriate branches). Digital subtraction angiography showed a large fusiform aneurysm (1.7 ϫ 1.5 ϫ 1.4 cm) that extended over the horizontal segment of the MCA (Fig. 1).The patient experienced a marked neurologic improvement. Because of the persistent risk for thromboembolism, endovascular treatment was performed. The patient was pretreated for 3 days with aspirin 325 mg/day and clopidogrel (Plavix) 75 mg/day. After induction of general anesthesia, a 6F Envoy guiding catheter (Cordis, Miami Lakes, Fla) was placed in the internal carotid artery. The patient was anticoagulated with intravenous administration of heparin; the activated clotting time at 2.5 times the basal level was maintained. The aneurysm was bypassed with a Prowler microcatheter (Cordis) distal to the neck of the aneurysm. A 300-cm, 0.0014-inch exchange wire was placed through the microcatheter. The microcatheter was removed, and a Vasco (Balt, Montmorency, France) microcatheter 21 was advanced over the wire to the intended site for the distal end of the stent. The wire was then removed. Thereafter, the LEO stent delivery system was advanced inside the Vasco, and a LEO stent (Balt; 3.5 ϫ 25 mm) was deployed easily over the neck of the aneurysm in a satisfactory position (Fig 2). The patient was maintained on daily aspirin (200 mg) and clopidogrel (75 mg) for 3 months after stent placement, after which the patient was switched to a single antipl...