Stent assisted coil embolization of unruptured middle cerebral artery aneurysms

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.

Download Full-text

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

Download Full-text

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

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2021.105773 ◽

2021 ◽

Vol 30 (7) ◽

pp. 105773

Author(s):

Kenta Fujimoto ◽

Hiroyuki Hashimoto ◽

Yoshitomo Uchiyama ◽

Hidetsugu Maekawa ◽

Yoichi Shida ◽

...

Keyword(s):

Literature Review ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Coil Embolization ◽

Middle Cerebral Artery Aneurysms

Download Full-text

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.

Download Full-text

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.

Download Full-text

Various Techniques of Stent-Assisted Coil Embolization of Wide-Necked or Fusiform Middle Cerebral Artery Aneurysms : Initial and Mid-Term Results

Journal of Korean Neurosurgical Society ◽

10.3340/jkns.2013.53.5.274 ◽

2013 ◽

Vol 53 (5) ◽

pp. 274 ◽

Cited By ~ 2

Author(s):

Yu Sam Won ◽

Myung Ho Rho ◽

Byung Moon Kim ◽

Hee Jin Park ◽

Hyon Ju Kwag ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Coil Embolization ◽

Middle Cerebral Artery Aneurysms ◽

Mid Term Results

Download Full-text

Feasibility and efficacy of coil embolization for middle cerebral artery aneurysms

Yeungnam University Journal of Medicine ◽

10.12701/yujm.2019.00192 ◽

2019 ◽

Vol 36 (3) ◽

pp. 208-218

Author(s):

Jae Young Choi ◽

Chang Hwa Choi ◽

Jun Kyeung Ko ◽

Jae Il Lee ◽

Chae Wook Huh ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Coil Embolization ◽

Middle Cerebral Artery Aneurysms

Download Full-text

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

Interventional Neuroradiology ◽

10.1177/1591019921990506 ◽

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.

Download Full-text