Sequential Coiling-Assisted Deployment of Flow Diverter for Treatment of Fusiform Middle Cerebral Artery Aneurysms

2017 ◽  
Vol 15 (2) ◽  
pp. E13-E18 ◽  
Author(s):  
Abdulrahman Y Alturki ◽  
Philip G R Schmalz ◽  
Christopher S Ogilvy ◽  
Ajith J Thomas
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Vascular Anatomy ◽  
Flow Diverter ◽  
Flow Diversion ◽  
Anterior Circulation ◽  
Vertebrobasilar System ◽  
Middle Cerebral Artery Aneurysms ◽  
Vessel Reconstruction

Abstract BACKGROUND AND IMPORTANCE Fusiform intracranial aneurysms remain challenging lesions to treat. These aneurysms have historically required bypass procedures or clip remodeling constructs for cure. Recently, endovascular specialists have reported experience with flow diversion for complex fusiform aneurysms of the vertebrobasilar system, with mixed results. Vascular anatomy for anterior circulation fusiform aneurysms may make these lesions more amenable to flow diversion and embolization procedures; however, published experience with these techniques is lacking. In this report, we describe a sequential coiling-assisted deployment of flow diverter for the treatment of fusiform middle cerebral artery (MCA-M1) aneurysms in 2 cases, 1 presenting acutely with subarachnoid hemorrhage and another with progressive aneurysm enlargement. CLINICAL PRESENTATION Two patients, a 36-yr-old male presenting with subarachnoid hemorrhage and a 60-yr-old female presenting with aneurysm enlargement were treated for fusiform aneurysms of the M1 segment of the MCA using a sequential, partial deployment of coils and flow diverter through 2 microcatheters to facilitate mutual mechanical support for both coil and flow diverter (Pipeline Embolization Device; Medtronic Inc, Dublin, Ireland). Both patients achieved favorable outcomes and follow-up angiography demonstrated complete vessel reconstruction in both cases. CONCLUSION The treatment of complex, fusiform, large vessel aneurysms remains challenging. As experience with new endovascular technologies and techniques grows, these lesions may be treated safely with interventional methods. The technique of partial flow diverter deployment and stabilization with coils with sequential delivery of both devices using dual microcatheter was both safe and effective.

Flow Diversion of an Incompletely-Treated Fusiform Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video

2019 ◽  
Author(s):  
Thomas J Sorenson ◽  
Jon P Klein ◽  
Leonardo Rangel-Castilla ◽  
Giuseppe Lanzino
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Aneurysm ◽  
Flow Diverter ◽  
Flow Diversion ◽  
Adjacent Segment ◽  
Middle Cerebral Artery Aneurysm ◽  
Parent Vessel ◽  
Vessel Reconstruction ◽  
Cerebral Artery Aneurysm

Abstract Fusiform aneurysms involving the M2 branches of the middle cerebral artery are often dissecting, identified by a characteristic diseased adjacent segment, and location not at a branch point. Herein, we present the case of a 38-yr-old man with a symptomatic, dissecting M2 aneurysm that was previously incompletely treated with stent-assisted coiling. In our experience, symptomatic fusiform aneurysms in this location tend to recur unless the involved segment is completely trapped or reconstructed with flow diversion. We successfully treated this patient with a vessel reconstruction using a Pipeline Flex Embolization Device (Medtronic). Deployment of a flow diverter inside a previously placed stent can pose potential challenges, as the original stent may constrain complete expansion of the flow diverter and prevent perfect apposition against the parent vessel wall. In this operative video, we demonstrate this technique and provide a brief discussion of the potential pitfalls.

Successful flow diversion treatment of ruptured infectious middle cerebral artery aneurysms with the use of Pipeline Flex with Shield technology

2021 ◽  
pp. 159101992199050
Author(s):  
Derek C Samples ◽  
Vijay M Ravindra ◽  
Dewey J Thoms ◽  
Izabela Tarasiewicz ◽  
Ramesh Grandhi
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Dual Antiplatelet Therapy ◽  
Flow Diverter ◽  
Flow Diversion ◽  
Parent Artery ◽  
Left Middle Cerebral Artery ◽  
Middle Cerebral Artery Aneurysms ◽  
Left Middle

Background Rupture of infectious intracranial aneurysms (IIAs) is associated with a high likelihood of mortality. Endovascular treatment of IIAs via parent artery sacrifice offers good efficacy and outcomes; however, depending on the lesion’s location, neurologic deficit may result. Case description We describe a pediatric patient with ruptured IIAs off the left middle cerebral artery (MCA) treated with coil embolization and endovascular flow diversion using the Pipeline Flex Embolization Device (PED) with Shield technology. We chose to place a flow diverter because 1) there was a second, more distal IIA not amenable to direct coil embolization, 2) there was significant potential for aneurysm regrowth and need for retreatment, and 3) we believed the diseased parent MCA needed to be reconstructed. Conclusions In the setting of previous hemicraniectomy, PED-Shield gave us the option to discontinue dual antiplatelet therapy should the patient require further neurosurgical intervention. Our case supports a role for PED-Shield to address ruptured pseudoaneurysms.

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

2017 ◽  
Vol 38 (12) ◽  
pp. 2289-2294 ◽  
Author(s):  
F. Cagnazzo ◽  
D. Mantilla ◽  
P.-H. Lefevre ◽  
C. Dargazanli ◽  
G. Gascou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Meta Analysis ◽  
Flow Diverter ◽  
Middle Cerebral Artery Aneurysms

E-018 Flow-Diversion for Complex Middle Cerebral Artery Aneurysms

2014 ◽  
Vol 6 (Suppl 1) ◽  
pp. A46.1-A46
Author(s):  
M Zanaty ◽  
N Chalouhi ◽  
S Tjoumakaris ◽  
L Gonzalez ◽  
R Rosenwasser ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Flow Diversion ◽  
Middle Cerebral Artery Aneurysms

scholarly journals Endovascular and Surgical Options for Ruptured Middle Cerebral Artery Aneurysms: Review of the Literature

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
David R. Santiago-Dieppa ◽  
Jeffrey S. Pannell ◽  
Alexander A. Khalessi
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Review Of The Literature ◽  
Surgical Options ◽  
Mca Aneurysm ◽  
Middle Cerebral Artery Aneurysms

Middle cerebral artery (MCA) aneurysms are common entities, and those of the bifurcation are the most frequently encountered sublocation of MCA aneurysm. MCA bifurcation (MBIF) aneurysms commonly present with subarachnoid hemorrhage (SAH), are devastating, and are often lethal. At the present time, the treatment of ruptured MBIF aneurysms entails either endovascular or open microneurosurgical methods to permanently secure the aneurysm(s). The purpose of this report is to review the current available data regarding the relative superiority of endovascular versus open microneurosurgical clipping for the treatment of ruptured middle cerebral artery bifurcation aneurysms.

Subarachnoid hemorrhage secondary to ruptured aneurysms in infants

1978 ◽  
Vol 49 (6) ◽  
pp. 898-902 ◽  
Author(s):  
Marshall L. Grode ◽  
Myles Saunders ◽  
Charles A. Carton
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Case Histories ◽  
Content Type ◽  
Ruptured Aneurysms ◽  
Detailed Case ◽  
Subarachnoid Bleeding ◽  
Middle Cerebral Artery Aneurysms ◽  
Fine Print

✓ Two infants with subarachnoid bleeding from middle cerebral artery aneurysms are presented, with detailed case histories.

Microsurgical and Angiographic Anatomy of Middle Cerebral Artery Aneurysms: Prevalence and Significance of Early Branch Aneurysms

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS344-ONS353 ◽  
Author(s):  
Arthur J. Ulm ◽  
Gregory L. Fautheree ◽  
Necmettin Tanriover ◽  
Antonino Russo ◽  
Erminia Albanese ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Retrospective Review ◽  
Intracerebral Hematoma ◽  
Aneurysm Neck ◽  
Average Patient ◽  
Ischemic Complications ◽  
Middle Cerebral Artery Aneurysms ◽  
Frontal Branch

Abstract Objective: To determine the prevalence of early branch aneurysms, characterize these lesions angiographically and anatomically, and determine their clinical significance. Methods: The authors conducted a retrospective review of 125 consecutive patients with a diagnosis of middle cerebral artery (MCA) aneurysm. Eighty-four patients harboring 100 MCA aneurysms were studied; 41 patients were excluded for lack of adequate imaging or for fusiform morphology of the aneurysm. Demographic characteristics including age, side, sex, subarachnoid hemorrhage, intracerebral hematoma, multiple aneurysms, and type of treatment were obtained. Results: The average patient age was 57.3 years (range, 29–79 yr); 69 were women and 15 were men. Fifty-eight were right MCA aneurysms and 42 were left aneurysms. Fourteen patients had multiple MCA aneurysms. Thirty-nine of 100 aneurysms were associated with subarachnoid hemorrhage. Twelve of 100 aneurysms were associated with an intracerebral hematoma. The average aneurysm sizes were 9.1 mm overall (range, 2.0–27.0 mm), 12.3 mm for ruptured aneurysms, and 7.5 mm for unruptured. There were 36 M1 bifurcation aneurysms, 39 early frontal branch aneurysms, 18 early temporal branch aneurysms, four lenticulostriate artery aneurysms, and three trifurcation aneurysms. Conclusion: In our retrospective review, the majority of MCA aneurysms arose along the M1 segment proximal to the M1 bifurcation. Early frontal branch aneurysms were more common than typical M1 segment bifurcation aneurysms. M1 segment aneurysms arising from early frontal and early temporal branches have distinct anatomic features that impact surgical management and outcome. Understanding the relationship between the recurrent lenticulostriate arteries arising from the proximal segments of these early branches and the aneurysm neck should allow surgeons to avoid many postoperative ischemic complications when dealing with these challenging lesions.

Coil Embolization of Unruptured Middle Cerebral Artery Aneurysms

Neurosurgery ◽  
2011 ◽  
Vol 68 (2) ◽  
pp. 346-354 ◽  
Author(s):  
Byung Moon Kim ◽  
Dong Ik Kim ◽  
Sung Il Park ◽  
Dong Joon Kim ◽  
Sang Hyun Suh ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Primary Treatment ◽  
Aneurysm Rupture ◽  
Endovascular Coiling ◽  
Unruptured Aneurysms ◽  
Permanent Morbidity ◽  
Middle Cerebral Artery Aneurysms

Abstract BACKGROUND: Since the International Subarachnoid Aneurysmal Trial, endovascular coiling has been increasingly used as primary treatment option for ruptured or unruptured aneurysms that are feasible for coiling. OBJECTIVE: To evaluate the feasibility and clinical and angiographic outcomes of coiling for unruptured middle cerebral artery aneurysms. METHODS: The records of 70 consecutive patients with 76 unruptured middle cerebral artery aneurysms who underwent coiling were retrospectively evaluated. RESULTS: Thirty-one aneurysms were treated by single-catheter, 18 by multicatheter, 11 by balloon-assisted, 13 by stent-assisted, and 3 by a combination of multicatheter and balloon-assisted techniques. Coiling was accomplished in 75 but failed in 1 aneurysm. One patient died of consequences of subarachnoid hemorrhage occurring 9 hours after coiling. One intraprocedural aneurysm rupture occurred, which was controlled by further coil insertions and left no sequelae. There were 1 cortical infarction and 1 basal ganglia infarction, both of which recovered completely. Treatment-related permanent morbidity and mortality rates were 0% and 1.4%, respectively. Postembolization control angiography revealed 40 complete, 30 neck remnant, and 5 incomplete occlusions. Clinical follow-up was available in all patients (mean, 25 months; range, 7-105 months). There was no subarachnoid hemorrhage during follow-up, but 1 death resulting from acute myocardial infarction occurred 3 months after coiling. None of the surviving patients had any neurological deterioration. Follow-up angiography was available in 69 aneurysms at 6 to 24 months (mean, 12 months). Three major and 6 minor recurrences were detected. All 3 major recurrent aneurysms were re-treated by coiling without any complications. CONCLUSION: Most unruptured middle cerebral artery aneurysms could be safely treated by coiling with acceptable short-term to midterm outcomes. Our results warrant further study with a longer follow-up period in a larger population.

Flow diverter device for the treatment of small middle cerebral artery aneurysms

2015 ◽  
Vol 8 (3) ◽  
pp. 287-294 ◽  
Author(s):  
Francesco Briganti ◽  
Luigi Delehaye ◽  
Giuseppe Leone ◽  
Carmine Sicignano ◽  
Giuseppe Buono ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Flow Diverter ◽  
Aneurysm Rupture ◽  
Side Branch ◽  
Neurological Deficits ◽  
Complete Occlusion ◽  
Ischemic Complications ◽  
Middle Cerebral Artery Aneurysms

PurposeExperience with the endovascular treatment of middle cerebral artery (MCA) aneurysms by flow diverter devices (FDD) is still limited. This study examines the results and complications of FDD for small aneurysms at this location.MethodsFrom February 2010 to December 2013, 14 patients (10 women; mean age 59 years) with 15 small MCA aneurysms were treated with FDD. All procedures were performed with the Pipeline embolization device (PED).ResultsComplete occlusion was obtained in 12/15 aneurysms (80%) and partial occlusion in 3 (20%). Among 13 aneurysms with a side branch, this was patent at the angiographic control in 4 cases, showed decreased filling in 6, and was occluded in 3 (with neurological deficits in 2). All PEDs were patent at follow-up. Post-procedural ischemic complications occurred in 4 (27%) procedures with permanent neurological deficit (modified Rankin score 2) in 3 (21%). No early or delayed aneurysm rupture, no subarachnoid or intraparenchymal hemorrhage and no deaths occurred.ConclusionsEndovascular treatment with FDD is a relatively safe treatment for small MCA aneurysms resulting in a high occlusion rate. The findings of this study suggest that complete occlusion after endovascular treatment with FDD can be delayed (>6 months). Ischemic complications may occur as early or delayed, particularly at clopidogrel interruption.

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