Comparison of the Efficacy and Safety of Endovascular Coiling Versus Microsurgical Clipping for Unruptured Middle Cerebral Artery Aneurysms: A Systematic Review and Meta-Analysis

Smith, Timothy R.; Coté, David J.; Dasenbrock, Hormuzdiyar H.; Hamade, Youssef J.; Zammar, Samer G.; Tecle, Najib E. El; Batjer, H. Hunt; Bendok, Bernard R.

doi:10.1016/j.wneu.2015.05.073

Cited by 98 publications

(60 citation statements)

References 38 publications

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“…The endovascular-first approach shift is not all encompassing, however, as over two-thirds of respondents continue to recommend microsurgical clipping as the preferred treatment for MCA bifurcation aneurysms. Although a small number of recent series support the safety of coiling for MCA aneurysms,19 20 there are no randomized controlled trials specifically comparing coiling versus clipping at this location, and the most rigorous analyses to date suggest the continued superiority of clipping 21 22…”

Section: Discussionmentioning

confidence: 99%

A survey of intracranial aneurysm treatment practices among United States physicians

Fargen

Soriano-Baron

Rushing

et al. 2017

J NeuroIntervent Surg

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Section: Discussionmentioning

confidence: 99%

A survey of intracranial aneurysm treatment practices among United States physicians

Fargen

Soriano-Baron

Rushing

et al. 2017

J NeuroIntervent Surg

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“…At the outset, we believed that the risk of morbidity and mortality inherent to cerebral revascularization procedures (reportedly between 7 and 26.5%) could be reduced to a level close to that expected for unruptured MCA aneurysm clipping (2.1%). [9] This was the main reason that led us to join these two surgical techniques in the treatment of this patient.…”

Section: Discussionmentioning

confidence: 99%

Treatment of complex intracranial aneurysm: Case report of the simultaneous use of endovascular and microsurgical techniques

St¹,

Rv²,

Hl³

et al. 2016

Surg Neurol Int

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Background:The surgical treatment of complex intracranial aneurysms (CIAs) represents a significant challenge to the skill and expertise of the neurosurgeon. The natural history of complex cerebrovascular lesions is especially unfavorable because of the pressure effect on adjacent areas, the risk of embolism in the presence of intraluminal thrombi, and the possibility of hemorrhage through leakage or rupture of the aneurysm. The surgical strategy must be customized for each case in order to maximize the treatment effectiveness and the safety of the patient.Case Description:A 68-year-old woman presented with a 10-month history of atypical headaches but no other neurological symptoms. Computed tomography scan and digital subtraction angiography revealed an unruptured saccular aneurysm on the M1 segment of the right middle cerebral artery. The lesion was 21 mm in length in its largest diameter and with an undefined neck (extensive involvement of the walls of the afferent vessel). Craniotomy was performed in order to expose the lesion and allow microsurgical dissection of the neck of the aneurysm and its adjacent structures. A balloon catheter was navigated via the internal carotid artery to a position alongside the aneurysm neck. With the balloon fully inflated, the aneurysm was punctured and drained, and a guide clip was located at the neck of the aneurysm. Additional clips were applied using a similar procedure to ensure the exclusion of the aneurysm.Conclusion:The patient recovered without complications and complete occlusion of the CIA was confirmed on follow-up angiography. A modified Rankin score of 0 was attributed to the patient 6 months after treatment. A multidisciplinary perspective is important in planning and executing the treatment of CIAs.

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“…Intracranial aneurysms (IAs) are saccular dilatations or outpouchings of brain arteries that are prone to rupture, causing death or severe morbidity in over half of the patients (Medical Advisory Secretariat, 2006). While minimally invasive endovascular therapy has many advantages and is increasingly being performed, the risk of IA recurrence remains higher compared to surgical clipping (Molyneux et al, 2015;Smith et al, 2015;Hulsbergen et al, 2019). Adjunctive devices such as flow diverting stents may decrease this risk by promoting endothelial growth at the neck of the IA (Ravindran et al, 2019) but currently require dual antiplatelet medication to avoid parent artery thrombosis, thereby increasing the risk of bleeding.…”

Section: Introductionmentioning

confidence: 99%

In vitro Implementation of Photopolymerizable Hydrogels as a Potential Treatment of Intracranial Aneurysms

Poupart

Schmocker

Conti

et al. 2020

Front. Bioeng. Biotechnol.

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Intracranial aneurysms are increasingly being treated with endovascular therapy, namely coil embolization. Despite being minimally invasive, partial occlusion and recurrence are more frequent compared to open surgical clipping. Therefore, an alternative treatment is needed, ideally combining minimal invasiveness and long-term efficiency. Herein, we propose such an alternative treatment based on an injectable, radiopaque and photopolymerizable polyethylene glycol dimethacrylate hydrogel. The rheological measurements demonstrated a viscosity of 4.86 ± 1.70 mPa.s, which was significantly lower than contrast agent currently used in endovascular treatment (p = 0.42), allowing the hydrogel to be injected through 430 µm inner diameter microcatheters. Photorheology revealed fast hydrogel solidification in 8 min due to the use of a new visible photoinitiator. The addition of an iodinated contrast agent in the precursor contributed to the visibility of the precursor injection under fluoroscopy. Using a customized light-conducting microcatheter and illumination module, the hydrogel was implanted in an in vitro silicone aneurysm model. Specifically, in situ fast and controllable injection and photopolymerization of the developed hydrogel is shown to be feasible in this work. Finally, the precursor and the polymerized hydrogel exhibit no toxicity for the endothelial cells. Photopolymerizable hydrogels are expected to be promising candidates for future intracranial aneurysm treatments.

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Comparison of the Efficacy and Safety of Endovascular Coiling Versus Microsurgical Clipping for Unruptured Middle Cerebral Artery Aneurysms: A Systematic Review and Meta-Analysis

Cited by 98 publications

References 38 publications

A survey of intracranial aneurysm treatment practices among United States physicians

A survey of intracranial aneurysm treatment practices among United States physicians

Treatment of complex intracranial aneurysm: Case report of the simultaneous use of endovascular and microsurgical techniques

In vitro Implementation of Photopolymerizable Hydrogels as a Potential Treatment of Intracranial Aneurysms

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