Results of endovascular treatment of middle cerebral artery aneurysms after first giving consideration to clipping

Abstract

At our hospital, MCA aneurysms are being treated with endovascular techniques, but in a minority of patients. Despite the rate of residual neck remnants, few retreatments were necessary and few rehemorrhages occurred. The periprocedural complication rate was not insignificant; therefore, in more recent years and at present, most MCA aneurysms are considered for clipping first at our center.

Surgical Management of Ruptured Middle Cerebral Artery Aneurysms With Large Intraparenchymal or Sylvian Fissure Hematomas

“…30 , an emerging endosaccular device and reported complete occlusion in 26.7% and a neck remnant in 56.7% of aneurysms at a median of 6-month followup. Use of these novel endoluminal and endosaccular devices requires dual-antiplatelet therapy to prevent thromboembolic events.…”

Endovascular and Surgical Options for Ruptured Middle Cerebral Artery Aneurysms: Review of the Literature

“…Many authors feel that surgical clipping offers select patients with ruptured MCA aneurysms the best long-term clinical outcome [32, 40–43]. …”

“…The Kuopio Cerebral Aneurysm Database found [3–6] that 29% of ruptured MBIF aneurysms presented with preoperative hydrocephalus. Abla et al [32] found that 24.2% of patients presented with hydrocephalus. Obstructive hydrocephalus in the setting of aSAH obviates the need for an external ventricular drain (EVD) which increases the risk of dual antiplatelet therapy.…”

“…More recently, Abla et al performed a retrospective review of all MCA aneurysms treated at single-intuition over a 5-year period [32]. Of the 149 MCA aneurysms included, surgical clipping was found to be the preferred method of treatment in 115 (77.2%) of cases.…”

“…Of the 149 MCA aneurysms included, surgical clipping was found to be the preferred method of treatment in 115 (77.2%) of cases. Of the remaining MCA aneurysms 22.8% were treated via endovascular techniques, 76.5% of which were MBIF aneurysms [32]. …”