Endovascular coil occlusion of 152 middle cerebral artery aneurysms: initial and midterm angiographic and clinical results

Abstract

S urgical clipping of MCA aneurysms is usually preferred to EVT. This preference is largely the result of a relatively easy surgical access and unfavorable endovascular approach due to the complex branching pattern of the MCA. As of this writing, no direct comparison between results of endovascular and surgical treatment of MCA aneurysms has been published in the literature, leaving the optimal treatment strategy unclear and choices depending mainly on the practice at the different centers. We therefore considered it important to study procedure-related risks as well as the immediate and midterm angiographic and clinical results after EVT of MCA aneurysms. MethodsFrom October 1992 to October 2001, a total of 940 patients with 1120 cerebral aneurysms were seen in our institute. Of these 940 patients, 202 (21.5%) were found to have MCA aneurysms (a total of 238 [21.3% of all identified aneurysms]). The closing date was chosen to have more than 5 years of follow-up data.Since the first use of detachable coils in our department in October 1992, data pertaining to all patients referred for EVT has been prospectively recorded. These data include: patients' demographic characteristics, mode of presentation, aneurysmal angiographic features, angiographic outcome at immediate post-EVT and follow-up examinations, procedure-related complications, and clinical status, using Hunt and Hess grading (in case of hemorrhage) on admission and GOS scores upon discharge Object. The object of this study was to evaluate the initial and mid-term angiographic and clinical results after endovascular coil occlusion of middle cerebral artery (MCA) aneurysms at the authors' institution.Methods. The authors conducted a retrospective analysis of a consecutive series of 152 MCA aneurysms (73 ruptured) treated by endovascular coiling in 140 patients. Angiographic and clinical data at initial and midterm follow-up as well as procedure-related complications were prospectively registered.Results. At discharge, favorable clinical outcomes (Glasgow Outcome Scale score of 1 or 2) were obtained in 89.3% of patients (125/140). Seven patients (5%) were in a vegetative state or had died. Complications were encountered in association with 11.8% of the procedures (18/152), and most (13/18) involved thromboembolic events (which led to permanent ischemia in 4 cases and death in 1). The overall procedure-related mortality rate was 0.7%, and the rates of permanent and transient morbidity were 2.6 and 2%, respectively. At a mean follow-up duration of 4.3 years there had been 4 cases of rebleeding: early rebleeding occurred during the initial postoperative period in 3 cases and later in 1. Total or subtotal occlusion was obtained in 84.2% of aneurysms (128/152). At follow-up, this satisfactory occlusion persisted in 83.3% of aneurysms (110/132) at 1 year posttreatment, 79.5% (89/112) at 3 years, and 80.2% (73/91) at 5 years.Conclusions. Risks and initial and midterm angiographic and clinical results after endovascular treatment of MCA aneurysms are nearly identi...

Endovascular Treatment of Middle Cerebral Artery Aneurysms for 120 Nonselected Patients: A Prospective Cohort Study

“…6 However, most of these series were highly focused on selected patients. [7][8][9][10] To date, with the advent of new endovascular tools such as balloons and stents designed specifically for the intracranial circulation, MCA aneurysms can be managed by means of the endovascular approach. However, the safety and efficacy of EVT for all patients are not well known yet.…”

Endovascular Treatment of 300 Consecutive Middle Cerebral Artery Aneurysms: Clinical and Radiologic Outcomes

“…Favorable clinical outcomes (mRS, 0 -2 and GOS, 5) in other large series of ruptured MCA aneurysms comprising at least 50 patients treated with EVC, are within the 67%-85% range. [10][11][12][13][14] In the present study, the largest published single-center experience to date, patients with consecutive ruptured MCA aneurysms achieved good outcome (GOS, 5) in 70.3% and favorable outcome (GOS, 4 and 5) in nearly 80%, with the proportion of favorable presenting clinical grade patients (WFNS, 1-2) being 72%. We were able to directly compare the results of our present study to a large audit of ruptured aneurysms at all locations treated through EVC at our institution with similar distribution of clinical grade.…”

“…The perforation rate lies within the range of previously published studies that have demonstrated procedural perforation complicating 1%-8.5% of MCA aneurysm treatments. [10][11][12][13][14]32 In 2 large prospective series of unruptured aneurysms (ATENA) 45 and ruptured aneurysms (CLARITY) treated by endovascular means, the perforation rate for MCA aneurysms was 4.1% and 8.5%, respectively. We have previously suggested that the rate of aneurysmal perforation may be higher at the MCA location 15 ; we demonstrated that MCA aneurysms accounted for 13% of cases but 24% of all intraprocedural ruptures.…”

“…In other endovascular series of at least 50 patients, re-treatment rates varied from 2.4%-13.9%. [10][11][12][13][14]32 It is well recognized that the decision to re-treat is highly variable. 37 Our cohort had no additional morbidity or mortality relating to the additional procedures, and in line with previous findings, 38,39 the risk for further coil embolization did not negate the advantage of the initial embolization.…”

Effect of Core Laboratory and Multiple-Reader Interpretation of Angiographic Images on Follow-Up Outcomes of Coiled Cerebral Aneurysms: A Systematic Review and Meta-Analysis

“…8 The current literature focusing on angiographic recanalization after coil embolization includes numerous and different strategies for image interpretation, including those done at the treating facility as well as those in a core laboratory. In addition, some reported studies rely on single observers, [9][10][11] whereas others report multiple-reader outcomes. [12][13][14] However, the impact of setting (site readings vs core facility interpretation) as well as singlereader vs multiple-reader studies remains poorly studied.…”