Treatment of middle cerebral artery (MCA) aneurysms: a review of the literature

Yang, Wuyang; Huang, Judy

doi:10.1186/s41016-015-0001-8

Cited by 19 publications

(17 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The reviewed surgical series reported occlusion rates between 90 and 89.3% with good clinical outcomes in 92–100% of unruptured and 70–80% of ruptured MCA aneurysms treated with clipping. The authors also suggested that the significantly higher retreatment rated and lower occlusion rates of the endovascular approach would offset the favorable clinical outcome in the short term of the less invasive approach ( 53 ).…”

Section: Discussionmentioning

confidence: 99%

Flow Diversion for the Treatment of MCA Bifurcation Aneurysms—A Single Centre Experience

et al. 2017

View full text Add to dashboard Cite

BackgroundIntracranial aneurysms located at the bifurcation of the middle cerebral artery (MCA) can often be challenging for the neurointerventionalist. We aimed to evaluate the efficacy and safety of flow diverting stents (FDS) in the treatment of these aneurysms.Materials and methodsWe retrospectively reviewed our prospectively maintained database to collect information for all patients with unruptured saccular bifurcation MCA aneurysms treated with FDS between January 2010 and January 2016. In addition to demographic data, we recorded the location, aneurysm characteristics, previous treatments, number and type of FDS, complications, and clinical and angiographic follow-up.ResultsOur search identified 13 patients (7 males) with an average age of 61.7 years (47–74 years). All patients had a single bifurcation aneurysm of the MCA, and none of the aneurysms were acutely ruptured. The average fundus size of the saccular aneurysms was 3 mm (range 1.5–10 mm). Follow-up studies were available for 12 patients. Based on the most recent follow-up angiograms, six aneurysms (50%) were totally occluded; five aneurysms (41.7%) showed only a small remnant; and one aneurysm (8.3%) remained unchanged. One patient suffered from an ischemic stroke with resultant permanent hemiparesis (mRS 3). In another case, there was an in-stent thrombosis during the intervention, which resolved upon intra-arterial infusion of Eptifibatide (mRS 0). There were no intra-operative vessel or aneurysm ruptures and no mortalities. Angiography of the covered MCA branches showed no change in the caliber or flow of the vessel in six (50%), a reduction in caliber in five (41.7%), and a complete occlusion in one (8.3%). All caliber changes and occlusions of the vessels were asymptomatic.ConclusionIn our series, 91.7% of treated MCA bifurcation aneurysms were either completely occluded or showed only a small remnant with a good safety profile. Flow diversion of MCA bifurcation aneurysms should be considered as an alternative treatment strategy when microsurgical clipping or alternative endovascular treatment options are not feasible.

show abstract

Section: Discussionmentioning

confidence: 99%

Flow Diversion for the Treatment of MCA Bifurcation Aneurysms—A Single Centre Experience

et al. 2017

View full text Add to dashboard Cite

show abstract

“…The middle cerebral artery was chosen for this project because approximately 14.0%–43.0% of all cerebral aneurysms in humans occur at sites associated with this artery . The concentration of vasopressin used in our experiments (1.4 × 10 −11 mol/L) is comparable to that observed in plasma and cerebrospinal fluid of the patients with SAH and is below the threshold for vasoconstriction of cerebral blood vessels in physiological conditions.…”

Section: Discussionmentioning

confidence: 93%

Dysfunction of the endothelium and constriction of the isolated rat's middle cerebral artery in low sodium environment in the presence of vasopressin

Aleksandrowicz

Klapczyńska

Koźniewska

2020

Clin Exp Pharma Physio

View full text Add to dashboard Cite

Hyponatraemia, a water–electrolyte disorder diagnosed in patients with subarachnoid haemorrhage (SAH), increases a risk of persistent vasospasm. In majority of cases, hyponatraemia results from inappropriate secretion of vasopressin (AVP). The effect of AVP‐associated hyponatraemia on cerebral vasculature is unknown. The present study aimed to elucidate the role of AVP in the response of the middle cerebral artery (MCA) of the rat to hyponatraemia. Isolated, cannulated, and pressurized rat MCAs were perfused/superfused with physiological (Na+ = 144 mmol/L) buffer or low‐sodium (Na+ = 121 mmol/L) buffer containing either AVP or angiotensin II (ANG II). ANG II was used to check if the effect of low plasma sodium concentration combined with AVP on the MCA tone is unique to vasopressin. At physiological Na+ concentration, vasopressin (1.4 × 10−11 mol/L) or angiotensin II (10−9 mol/L) resulted in relaxation of the MCA. Substitution of low‐sodium for the normal sodium buffer with the same concentration of AVP, resulted in the constriction of the MCA. This effect was absent after removal of the endothelium, administration of vasopressin V1 receptor antagonist or concomitant inhibition of endothelin‐1 receptors and synthesis of thromboxane A2. In contrast, no constriction of the MCA in low‐sodium buffer was observed when AVP was replaced with ANG II. Our data suggest that presence of vasopressin and low sodium ion concentration results in the change of endothelium phenotype from pro‐vasodilatory to pro‐vasoconstrictory. This phenomenon may be an overlooked factor contributing to vasospasm in SAH patients with hyponatraemia caused by inappropriate antidiuretic hormone secretion (SIADH).

show abstract

“…This rate is lower than the occlusion rates reported with clipping (> 90%) in most studies. 26 Clinical data should demonstrate better or similar results than clipping to challenge surgical management.…”

Section: Discussionmentioning

confidence: 99%

Aneurysms with persistent filling after failed treatment with the Pipeline embolization device

Daou

Atallah

Chalouhi

et al. 2019

Journal of Neurosurgery

View full text Add to dashboard Cite

OBJECTIVEThe Pipeline embolization device (PED) has become a valuable tool in the treatment of cerebral aneurysms. Although failures with PED treatment have been reported, the characteristics and course of these aneurysms remain a topic of uncertainty.METHODSElectronic medical records and imaging studies were reviewed for all patients treated with the PED between July 2010 and March 2015 to identify characteristics of patients and aneurysms with residual filling after PED treatment.RESULTSOf 316 cases treated at a single institution, 281 patients had a long-term follow-up. A total of 52 (16.4%) aneurysms with residual filling were identified and constituted the study population. The mean patient age in this population was 58.8 years. The mean aneurysm size was 10.1 mm ± 7.15 mm. Twelve aneurysms were fusiform (23%). Of the aneurysms with residual filling, there were 20 carotid ophthalmic (CO) aneurysms (20% of all CO aneurysms treated), 10 other paraclinoid aneurysms (16.4% of all paraclinoid aneurysms), 7 posterior communicating artery (PCoA) aneurysms (21.9% of all PCoA aneurysms), 7 cavernous internal carotid artery (ICA) aneurysms (14.9% of all cavernous ICA aneurysms), 4 vertebrobasilar (VB) junction aneurysms (14.8% of all VB junction aneurysms), and 3 middle cerebral artery (MCA) aneurysms (25% of all MCA aneurysms). Eleven patients underwent placement of more than one PED (21.2%), with a mean number of devices of 1.28 per case. Eight of 12 aneurysms were previously treated with a stent (15.4%). Nineteen patients underwent re-treatment (36.5%); the 33 patients who did not undergo re-treatment (63.5%) were monitored by angiography or noninvasive imaging. In multivariate analysis, age older than 65 years (OR 2.65, 95% CI 1.33–5.28; p = 0.05), prior stent placement across the target aneurysm (OR 2.94, 95% CI 1.15–7.51; p = 0.02), aneurysm location in the distal anterior circulation (MCA, PCoA, and anterior choroidal artery: OR 2.72, 95% CI 1.19–6.18; p = 0.017), and longer follow-up duration (OR 1.06, 95% CI 1.03–1.09; p < 0.001) were associated with incomplete aneurysm occlusion.CONCLUSIONSWhile the PED can allow for treatment of large, broad-necked aneurysms with high efficacy, treatment failures do occur (16.4%). Aneurysm size, shape, and previous treatment may influence treatment outcome.

show abstract

Treatment of middle cerebral artery (MCA) aneurysms: a review of the literature

Cited by 19 publications

References 49 publications

Flow Diversion for the Treatment of MCA Bifurcation Aneurysms—A Single Centre Experience

Flow Diversion for the Treatment of MCA Bifurcation Aneurysms—A Single Centre Experience

Dysfunction of the endothelium and constriction of the isolated rat's middle cerebral artery in low sodium environment in the presence of vasopressin

Aneurysms with persistent filling after failed treatment with the Pipeline embolization device

Contact Info

Product

Resources

About