Endovascular coil embolization of middle cerebral artery aneurysms of the proximal (M1) segment

Cho, Young Dae; Lee, Woong Jae; Kim, Kang Min; Kang, Hyun-Seung; Kim, Jeong Eun; Han, Moon Hee

doi:10.1007/s00234-013-1190-5

Cited by 35 publications

(16 citation statements)

References 17 publications

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“…Improvements in protective devices and coiling techniques, including balloon remodeling and stent protection have rendered many previously ineligible aneurysms with difficult configurations amenable to selective endovascular treatment ( 16 ). However, angio-anatomic complexities, including extreme vessel tortuosity or intricate vascular arrangements occasionally prohibit using these techniques ( 17 ). Dual microcatheter coil embolization, pioneered by Baxter et al ( 10 ), may be a viable alternate technical strategy for challenging wide-neck intracranial aneurysms ( 11 12 18 19 ), although two microcatheters are occasionally insufficient to form a stable coil frame without protrusion or to protect the parent artery from impingement.…”

Section: Discussionmentioning

confidence: 99%

Use of Triple Microcatheters for Endovascular Treatment of Wide-Necked Intracranial Aneurysms: A Single Center Experience

et al. 2015

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ObjectiveThe dual microcatheter technique is common practice for coil embolization of a wide-necked aneurysm, due to safety and efficacy. However, technical limitations of some complex configurations may necessitate additional microcatheters to bolster coil stability, compact the coil, or for protection. Described herein is a triple microcatheter technique for endovascular management of wide-necked intracranial aneurysms.Materials and MethodsData accruing prospectively between January 2006 and October 2014 on simultaneously executed triple microcatheter coil embolization procedures done in 38 saccular aneurysms were reviewed. Clinical and morphological outcomes were assessed, with emphasis on technical aspects of treatment.ResultsThe triple microcatheter technique was successfully applied to all 38 saccular aneurysms, involving the posterior communicating artery (n = 13), the middle cerebral artery (n = 10), the basilar tip (n = 7), the anterior cerebral artery (n = 5), and the internal carotid artery (n = 3). Stent protection was added in four patients and balloon remodeling in one. Dual microcatheters (n = 24) were usually deployed to deliver the coil within sacs of aneurysms, with the additional microcatheter used for protection. Otherwise, triple microcatheters were deployed for coil delivery (n = 11) or coils were delivered via a single microcatheter, with dual microcatheters deployed for protection (n = 3). Successful occlusion of aneurysms was achieved in 89.5% of cases, with no procedure-related morbidity or mortality. Stable occlusion was maintained in 72.2% (26/36) of the aneurysms at the final follow-up (mean interval, 30.2 ± 22.7 months).ConclusionThe outcomes of this limited study suggest that the triple microcatheter technique may be an effective and safe therapeutic option for wide-necked aneurysms, using technical strategies tailored to complex angio-anatomic configurations.

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Section: Discussionmentioning

confidence: 99%

Use of Triple Microcatheters for Endovascular Treatment of Wide-Necked Intracranial Aneurysms: A Single Center Experience

et al. 2015

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“…13 As endovascular treatment strategies continue to evolve, reports are increasing about the treatment of ruptured MCA aneurysms with endovascular strategies. 4,6,9,10,12,14,16,17,27 In the largest series in the endovascular literature to date, Mortimer et al 14 Although some selection bias might be present in their series, Mortimer et al 14 noted that they practice a "coilfirst" policy at their institution and that only 51 patients with ruptured MCA aneurysms were treated with primary clipping during roughly the same period. Twenty-one of these patients were noted to have poor anatomy for endovascular treatment or had already undergone an unsuccessful attempt at coiling, whereas the remainder of those who underwent clipping did so because of surgeon preference or the lack of availability of an interventional neuroradiologist.…”

Section: Discussionmentioning

confidence: 99%

Long-term results of middle cerebral artery aneurysm clipping in the Barrow Ruptured Aneurysm Trial

Mooney¹,

Simon²,

Brigeman³

et al. 2019

Journal of Neurosurgery

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OBJECTIVE A direct comparison of endovascular versus microsurgical treatment of ruptured middle cerebral artery (MCA) aneurysms in randomized trials is lacking. As endovascular treatment strategies continue to evolve, the number of reports of endovascular treatment of these lesions is increasing. Herein, the authors report a detailed post hoc analysis of ruptured MCA aneurysms treated by microsurgical clipping from the Barrow Ruptured Aneurysm Trial (BRAT). METHODS The cases of patients enrolled in the BRAT who underwent microsurgical clipping for a ruptured MCA aneurysm were reviewed. Characteristics of patients and their clinical outcomes and long-term angiographic results were analyzed. RESULTS Fifty patients underwent microsurgical clipping of a ruptured MCA aneurysm in the BRAT, including 21 who crossed over from the endovascular treatment arm. Four patients with nonsaccular (e.g., dissecting, fusiform, or blister) aneurysms were excluded, leaving 46 patients for analysis. Most (n = 32; 70%) patients presented with a Hunt and Hess grade II or III subarachnoid hemorrhage, with a high prevalence of intraparenchymal blood (n = 23; 50%), intraventricular blood (n = 21; 46%), or both. At the last follow-up (up to 6 years after treatment), clinical outcomes were good (modified Rankin Scale score 0-2) in 70% (n = 19) of 27 Hunt and Hess grades I-III patients and in 36% (n = 4) of 11 Hunt and Hess grade IV or V patients. There were no instances of rebleeding after the surgical clipping of aneurysms in this series at the time of last clinical follow-up. CONCLUSIONS Microsurgical clipping of ruptured MCA aneurysms has several advantages over endovascular treatment, including durability over time. The authors report detailed outcome data of patients with ruptured MCA aneurysms who underwent microsurgical clipping as part of a prospective, randomized trial. These results should be used for comparison with future endovascular and surgical series to ensure that the best results are being achieved for patients with ruptured MCA aneurysms.

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“…One of the most important factors in microcatheter selection of intracranial aneurysms (including paraclinoid aneurysms) is a properly configured distal tip, either pre-shaped or steam-shaped ( 12 18 19 ). As shown in Table 2 , consistencies in microcatheter shape are evident, depending on how a dome of aneurysm is directed (relative to carotid siphon).…”

Section: Discussionmentioning

confidence: 99%

Microcatheter Looping to Facilitate Aneurysm Selection in Coil Embolization of Paraclinoid Aneurysms

et al. 2015

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ObjectiveDescribed herein is a microcatheter looping technique to facilitate aneurysm selection in paraclinoid aneurysms, which remains to be technically challenging due to the inherent complexity of regional anatomy.Materials and MethodsThis retrospective study was approved by our Institutional Review Board, and informed consent was waived. Microcatheter looping method was employed in 59 patients with paraclinoid aneurysms between January 2012 and December 2013. In the described technique, construction of a microcatheter loop, which is steam-shaped or pre-shaped, based on the direction of aneurysms, is mandatory. The looped tip of microcatheter was advanced into distal internal carotid artery and positioned atop the target aneurysm. By steering the loop (via inner microguidewire) into the dome of aneurysm and easing tension on the microcatheter, the aneurysm was selected. Clinical and morphologic outcomes were assessed with emphasis on technical aspects of the treatment.ResultsThrough this looping technique, a total of 59 paraclinoid aneurysms were successfully treated. After aneurysm selection as described, single microcatheter technique (n = 25) was most commonly used to facilitate coiling, followed by balloon protection (n = 21), stent protection (n = 7), multiple microcatheters (n = 3), and stent/balloon combination (n = 3). Satisfactory aneurysmal occlusion was achieved through coil embolization in 44 lesions (74.6%). During follow-up of 53 patients (mean interval, 10.9 ± 5.9 months), only one instance (1.9%) of major recanalization was observed. There were no complications related to microcatheter looping.ConclusionThis microcatheter looping method facilitates safe and effective positioning of microcatheter into domes of paraclinoid aneurysms during coil embolization when other traditional microcatheter selection methods otherwise fail.

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Endovascular coil embolization of middle cerebral artery aneurysms of the proximal (M1) segment

Abstract: Coil embolization in M1 aneurysms seems to be safe and efficacious, although it may require various technical strategies due to distinct anatomic configurations.

Cited by 35 publications

References 17 publications

Use of Triple Microcatheters for Endovascular Treatment of Wide-Necked Intracranial Aneurysms: A Single Center Experience

Use of Triple Microcatheters for Endovascular Treatment of Wide-Necked Intracranial Aneurysms: A Single Center Experience

Long-term results of middle cerebral artery aneurysm clipping in the Barrow Ruptured Aneurysm Trial

Microcatheter Looping to Facilitate Aneurysm Selection in Coil Embolization of Paraclinoid Aneurysms

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