Flow Diversion for the Treatment of MCA Bifurcation Aneurysms—A Single Centre Experience

Abstract

BackgroundIntracranial aneurysms located at the bifurcation of the middle cerebral artery (MCA) can often be challenging for the neurointerventionalist. We aimed to evaluate the efficacy and safety of flow diverting stents (FDS) in the treatment of these aneurysms.Materials and methodsWe retrospectively reviewed our prospectively maintained database to collect information for all patients with unruptured saccular bifurcation MCA aneurysms treated with FDS between January 2010 and January 2016. In addition to demographic data, we recorded the location, aneurysm characteristics, previous treatments, number and type of FDS, complications, and clinical and angiographic follow-up.ResultsOur search identified 13 patients (7 males) with an average age of 61.7 years (47–74 years). All patients had a single bifurcation aneurysm of the MCA, and none of the aneurysms were acutely ruptured. The average fundus size of the saccular aneurysms was 3 mm (range 1.5–10 mm). Follow-up studies were available for 12 patients. Based on the most recent follow-up angiograms, six aneurysms (50%) were totally occluded; five aneurysms (41.7%) showed only a small remnant; and one aneurysm (8.3%) remained unchanged. One patient suffered from an ischemic stroke with resultant permanent hemiparesis (mRS 3). In another case, there was an in-stent thrombosis during the intervention, which resolved upon intra-arterial infusion of Eptifibatide (mRS 0). There were no intra-operative vessel or aneurysm ruptures and no mortalities. Angiography of the covered MCA branches showed no change in the caliber or flow of the vessel in six (50%), a reduction in caliber in five (41.7%), and a complete occlusion in one (8.3%). All caliber changes and occlusions of the vessels were asymptomatic.ConclusionIn our series, 91.7% of treated MCA bifurcation aneurysms were either completely occluded or showed only a small remnant with a good safety profile. Flow diversion of MCA bifurcation aneurysms should be considered as an alternative treatment strategy when microsurgical clipping or alternative endovascular treatment options are not feasible.

Treatment of Unruptured Distal Anterior Circulation Aneurysms with Flow-Diverter Stents: A Meta-Analysis

“…Overall, 22 included studies were retrospective series, 1,2,4,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] whereas 5 articles were prospective series (details in On-line Table 3). [29][30][31][32][33]…”

Treatment of Middle Cerebral Artery Aneurysms with Flow-Diverter Stents: A Systematic Review and Meta-Analysis

“…Overall, previous series have reported a rate of complete/near-complete occlusion between 60% and 90% after flow-diversion treatment of MCA aneurysms. [5][6][7][8][9][12][13][14]20 The paucity of large and prospective studies, the heterogeneity of the reported populations, and the relatively short follow-up periods can explain this variation. Our study, the largest to date, demonstrated that the overall rate of complete/near-complete occlusion is roughly 80% during a mean follow-up of 14 months.…”

“…1 Recently, flow diversion has been used as an alternative technique for complex wide-neck MCA aneurysms, incorporating Ն1 side branch or in cases of previous endovascular or surgical failure. [5][6][7][8][9][10][11][12][13][14] However, the role of flow diversion in this location is controversial, and the efficacy and safety of this technique remain unclear. We performed a systematic review and meta-analysis of all published series examining flow diversions for the treatment of MCA aneurysms with the aim of clarifying the following: 1) aneurysm occlusion rate, 2) treatment-related complications and clinical outcome, and 3) the fate of the MCA side branch covered with the device.…”

Stent-Assisted Coiling of Ruptured and Incidental Aneurysms of the Intracranial Circulation Using Moderately Flow-Redirecting, Braided Leo Stents—Initial Experience in 39 Patients

“…Hence, a subsidiary endovascular approach, flow diversion (FD), was introduced to further enhance endovascular aneurysm therapy ( 5 ). FD has been established as a successful technique to neutralize wide-neck sidewall aneurysms with saccular configuration, selected bifurcation aneurysms, fusiform aneurysms, and dissecting aneurysms of the intracranial circulation ( 6 – 12 ). FD uses devices with significantly increased material coverage in comparison with conventional stents, aiming to reconstruct the parent vessel whilst excluding the aneurysm from the circulation ( 5 , 13 , 14 ).…”