Duplicated Middle Cerebral Artery Aneurysms Treated by Coil Embolization; A Report of Two Cases and Literature Review

ABSTRACT BACKGROUND: Protection techniques using stents or microcatheters allow treatment of aneurysms with complex configurations by coil embolization. However, the application of these techniques is occasionally limited in wide-neck middle cerebral artery (MCA) aneurysms with acute angularity of the efferent branch vessel. OBJECTIVE: We describe a looping technique for passage of a microcatheter and microwire into the acutely angled efferent branch vessel without navigating the system through the aneurysm lumen. METHODS: To select the acutely angulated branch, a looped microcatheter was advanced near the orifice of the distal acutely angled branch vessel, followed by microwire passage through the looped microcatheter into the efferent vessel. The microcatheter loop was straightened after the microwire had been sufficiently advanced. The microcatheter was then navigated into the distal branch vessel over the advanced microwire. RESULTS: A total of 36 wide-neck MCA aneurysms were successfully treated using this looping method. This technique was used to pass the microcatheter for stent protection in 13 patients and for microcatheter protection in 23. The method was most commonly used for aneurysms located at the M1 trunk (n = 21), followed by the MCA bifurcation (n = 15). Complete or near-complete endosaccular occlusion was achieved in 31 aneurysms. There were no complications related to looping the microcatheter. CONCLUSION: This microcatheter looping technique facilitates safe entry into the distal branch during coil embolization of wide-neck MCA aneurysms incorporating the origins of acutely angulated branches.

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Coil embolization of ruptured middle cerebral artery aneurysms in the first 2 months of life

Journal of Neurosurgery Pediatrics ◽

10.3171/ped-07/09/232 ◽

2007 ◽

Vol 107 (3) ◽

pp. 232-235 ◽

Cited By ~ 2

Author(s):

Arnab K. Rana ◽

Panos Koumellis ◽

Timothy Jaspan ◽

Maria Cartmill ◽

Norman S. Mcconachie

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Coil Embolization ◽

Middle Cerebral Artery Aneurysms

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Distal Middle Cerebral Artery Aneurysms

Interventional Neuroradiology ◽

10.1177/159101990200800409 ◽

2002 ◽

Vol 8 (4) ◽

pp. 399-407 ◽

Cited By ~ 13

Author(s):

F. Baltacioğlu ◽

S. Cekirge ◽

I. Saatci ◽

H. Öztürk ◽

A. Arat ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Coil Embolization ◽

Surgical Techniques ◽

Neurological Deficits ◽

Parent Artery ◽

Aneurysm Embolization ◽

Intracranial Arteries ◽

Middle Cerebral Artery Aneurysms ◽

Distal Middle Cerebral Artery

Intracranial aneurysms of the distal intracranial arteries are uncommon lesions which are difficult to treat with surgical techniques. Distal middle cerebral artery (MCA) aneurysms constitute approximately 5% of all MCA aneurysms. We report the results of our coil embolization for the treatment of distal MCA aneurysms. Eleven patients (four men and seven women, average age 37 years) with distally located MCA aneurysms were treated. Four of the aneurysms were fusiform in shape and the remainder were saccular. Seven of the aneurysms were in the dominant hemisphere. Four of the seven patients who had saccular aneurysms were treated with selective aneurysm embolization. The remaining seven patients were treated with aneurysmal sac and parent artery coiling. All patients had good retrograde flow into the peripheral branches of the occluded artery. All the procedures were completed successfully without any additional neurological deficits. Coil embolization is a safe and effective technique for the treatment of distal MCA aneurysms. If the parent artery cannot be preserved, pial collaterals can supply adequate blood to prevent neurological deficits.

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Stent assisted coil embolization of unruptured middle cerebral artery aneurysms

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2011-010162 ◽

2011 ◽

Vol 5 (1) ◽

pp. 15-19 ◽

Cited By ~ 25

Author(s):

Jeremy D Fields ◽

Lucas Brambrink ◽

Aclan Dogan ◽

Erek K Helseth ◽

Kenneth C Liu ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Coil Embolization ◽

Middle Cerebral Artery Aneurysms

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Endovascular coil embolization of proximal middle cerebral artery aneurysms has better outcomes than other middle cerebral artery aneurysms: A retrospective study

Interventional Neuroradiology ◽

10.1177/1591019919896459 ◽

2020 ◽

Vol 26 (3) ◽

pp. 268-274

Author(s):

Hirotaka Sato ◽

Koichi Haraguchi ◽

Yasuhiro Takahashi ◽

Shunya Ohtaki ◽

Tadakazu Shimizu ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Coil Embolization ◽

Univariate Analysis ◽

Insular Cortex ◽

Class 1 ◽

Endovascular Coil Embolization ◽

Proximal Middle Cerebral Artery ◽

Operative Notes ◽

Middle Cerebral Artery Aneurysms

Purpose Although some authors proposed that coil embolization in middle cerebral artery (MCA) aneurysms is a useful and effective alternative, the characteristics of the aneurysms may be different at each location. We compared the results of coil embolization of proximal middle cerebral artery aneurysms with those of other middle cerebral artery aneurysms. Methods Data from 46 patients with 50 aneurysms were retrospectively evaluated. We defined the aneurysms inside of the insular cortex as proximal MCA (pMCA) aneurysms and those outside of the insular cortex as non-proximal MCA (npMCA) aneurysms. The results of the occlusion were divided into classes 1, 2, and 3 of the Raymond scale. We collected the results of the occlusion from the operative notes supplied by a neuroendovascular specialist. Results Univariate analysis identified favorable results for pMCA aneurysms (class 1: pMCA = 22 npMCA = 11; P < 0.01). In the radiological follow-up results, we achieved class 1 in 29 patients (69%; pMCA = 21 and npMCA = 8; P < 0.01). Side wall type aneurysms (pMCA = 14, npMCA = 2; P < 0.01) and the number of branches from the neck of ≤1 (pMCA = 14, npMCA = 2; P < 0.01) were significantly recognized at the pMCA. Conclusions Proximal middle cerebral artery aneurysm clipping is difficult because the origin of the lenticulostriate arteries is often hidden behind the aneurysmal dome. In the present study, endovascular coil embolization for pMCA aneurysms obtained better results than that for npMCA aneurysms because of the morphological characteristics. Endovascular coil embolization seems to be efficacious for pMCA aneurysms as compared with npMCA aneurysms.

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Intrasylvian/Intracerebral Hematomas Associated with Ruptured Middle Cerebral Artery Aneurysms: A Single-Center Series and Literature Review

World Neurosurgery ◽

10.1016/j.wneu.2016.11.022 ◽

2017 ◽

Vol 98 ◽

pp. 432-437 ◽

Cited By ~ 6

Author(s):

Yupeng Zhang ◽

Quan Hu ◽

Hao Xue ◽

Mingran Zhang ◽

Jie Shen ◽

...

Keyword(s):

Literature Review ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Single Center ◽

Middle Cerebral Artery Aneurysms

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Endovascular treatment of distal middle cerebral artery aneurysms: Report of eight cases and literature review

Interventional Neuroradiology ◽

10.1177/1591019915617317 ◽

2015 ◽

Vol 22 (1) ◽

pp. 12-17 ◽

Cited By ~ 11

Author(s):

Nan Lv ◽

Yu Zhou ◽

Pengfei Yang ◽

Qiang Li ◽

Rui Zhao ◽

...

Keyword(s):

Retrospective Study ◽

Literature Review ◽

Endovascular Treatment ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Open Surgery ◽

Alternative Choice ◽

Middle Cerebral Artery Aneurysms ◽

Distal Middle Cerebral Artery

Background Endovascular treatment is an alternative choice for the treatment of distal middle cerebral artery (dMCA) aneurysm, in addition to open surgery; but is still seldom considered. We performed this retrospective study to evaluate the outcome of dMCA in patients. Methods During a period of 10 years, we were able to identify seven patients with a total of eight dMCA aneurysms that were treated endovascularly. They were five men and two women, with a mean age of 36.1 years. All of the aneurysms, including five infectious and three dissecting ones, were treated for the aneurysm and its parent artery’s occlusion, using coils and/or glue. Results The clinical follow-up (9–96 m, mean 36.8 m) showed that they all improved over baseline; except for one patient in whom a mild right hemiparesis remained, after the hematoma evacuation. Angiographic follow-up (7–24 m; mean: 14.6 m) showed that all of them were stable and without the need for recanalization. Conclusions Our data indicated that endovascular treatment is a safe and effective alternative for the treatment of dMCA aneurysms, and should be considered when treating these aneurysms.

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