Endovascular coil placement compared with surgical clipping for the treatment of unruptured middle cerebral artery aneurysms: a consecutive series

Abstract

Careful evaluation of the angioanatomy of unruptured aneurysms allows selection of the most appropriate treatment. However, for unruptured MCA aneurysms, surgical clipping appears to be the most efficient treatment option. Series of unruptured aneurysms are ideal for comparing treatment results.

Endovascular Treatment of Middle Cerebral Artery Aneurysms as First Option: A Single Center Experience of 92 Aneurysms

“…In the series reported by Raftopoulos et al, 4 the proportion of aneurysms proposed for coil embolization was similar, but embolization of the MCAA was responsible for 41.7% of the total failures of this technique of treatment. In 1999, Regli et al 2,3 reported 85% of failures for the EVT of unruptured MCAAs. In addition, the authors of a recent series found that, on the basis of 3D imaging, only 16.1% of all MCAAs were suitable for EVT, and they obtained a complete occlusion rate of 86.8%.…”

“…Then, the feasibility of EVT of MCAAs is greater than expected before. [2][3]8 However, a precise analysis of complications and anatomic results is needed to define the place of the EVT in the management of MCAAs. Overall, treatment-related adverse events with or without clinical modification were encountered in 13 patients (25.5%).…”

“…This is mainly because of the anatomic characteristics of these aneurysms, which often have wide necks and branches arising from the neck, and also because of their proximity to the cerebral surface, which facilitates surgical access. [2][3][4][5] The aim of this study was, therefore, to analyze retrospectively the feasibility and efficacy of ruptured and unruptured MCAA embolization in a center where this option is the first one considered.…”

Tratamento cirúrgico dos aneurismas não rotos da artéria cerebral média

“…Este é o principal diferencial em relação ao tratamento endovascular,estando de acordo com Regli e col. 23 . Quanto à idade dos pacientes e o tamanho dos aneurismas, embora alguns estudos estabeleçam limite para o tratamento cirúrgico 1,23 , o mais importante é a individualização, devendose levar em consideração outras comorbidades, facilidade do acesso cirúrgico e a experiência do cirurgião.…”

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

“…In addition, as suggested by Rodriguez and authors [15], the distribution of aneurysm locations in the ISAT study is significantly different from what was previously reported, with MCA aneurysms comprising only 14.0 % of all aneurysms in ISAT as compared to approximately 25.0 % in reported literature, suggesting a potential sampling bias that favors maximizing outcome in the coiling group. Furthermore, current available comparative studies and meta-analyses on MCA aneurysm treatment suggested slight to moderate advantage of clipping over coiling [24,30,31,42]. Therefore, further investigation is warranted for justification of endovascular therapy as a viable alternative to surgical therapy in definitive treatment of MCA aneurysms.…”