Endovascular Coiling Compared with Surgical Clipping for the Treatment of Unruptured Middle Cerebral Artery Aneurysms: An Update

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

“…Because of their morphology, middle cerebral artery aneurysms can be difficult to treat by coil embolization, 117,255,285,286 and surgical results for these aneurysms are often reported as more favorable than for other lesions. 286 -289 However, aneurysms in the posterior cerebral circulation are frequently more difficult to treat with surgery, 73 and comparative observational studies have found better outcomes after coil embolization in these locations.…”

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.…”

Stent-Assisted Coiling of Complex Middle Cerebral Artery Aneurysms: Initial and Midterm Results

“…3 Consequently, the optimal therapeutic management of MCA aneurysms is still considered controversial, and surgical clipping remains the standard treatment in many institutions. [4][5][6][7] Although MCA aneurysms were underrepresented in large EVT series, 2,8,9 low morbidity-mortality and aneurysm-recurrence rates have recently been reported in MCA aneurysm series, underlining the potential for EVT. [10][11][12] Furthermore, self-expandable intracranial stents became available in 2003 and have been reported as safe and effective, particularly in the treatment of complex aneurysms, [13][14][15][16][17][18][19] but without consistent data in the MCA location.…”