scholarly journals Wide-neck bifurcation aneurysms of the middle cerebral artery and basilar apex treated by endovascular techniques: a multicentre, core lab adjudicated study evaluating safety and durability of occlusion (BRANCH)

2018 ◽  
Vol 11 (1) ◽  
pp. 31-36 ◽  
Author(s):  
Reade A De Leacy ◽  
Kyle M Fargen ◽  
Justin R Mascitelli ◽  
Johanna Fifi ◽  
Lena Turkheimer ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Endovascular Techniques ◽  
Mortality And Morbidity ◽  
Patient Demographics ◽  
Procedural Information ◽  
Morbidity Data ◽  
Aneurysm Morphology ◽  
Wide Neck

Background and purposeBRANCH (wide-neck bifurcation aneurysms of the middle cerebral artery and basilar apex treated by endovascular techniques) is a multicentre, retrospective study comparing core lab evaluation of angiographic outcomes with self-reported outcomes.Materials and methodsConsecutive patients were enrolled from 10 US centres, aged between 18 and 85 with unruptured wide-neck middle cerebral artery (MCA) or basilar apex aneurysms treated endovascularly. Patient demographics, aneurysm morphology, procedural information, mortality and morbidity data and core lab and self-reported modified Raymond Roy (RR) outcomes were obtained.Results115 patients met inclusion criteria. Intervention-related mortality and significant morbidity rates were 1.7% (2/115) and 5.8% (6/103) respectively. Core lab adjudicated RR1 and 2 occlusion rates at follow-up were 30.6% and 32.4% respectively. The retreatment rate within the follow-up window was 10/115 (8.7%) and in stent stenosis at follow-up was 5/63 (7.9%). Self-reporting shows a statistically significant direction to angiographic RR one outcomes at follow-up compared with core lab evaluation, with OR 1.75 (95% CI 1.08 to 2.83).ConclusionEndovascular treatment of wide-neck MCA and basilar apex aneurysms resulted in a core lab adjudicated RR1 occlusion rate of 30.6%. Self-reported results at follow-up favour better angiographic outcomes, with OR 1.75 (95% CI 1.08 to 2.83). These data demonstrate the need for novel endovascular devices specifically designed to treat complex intracranial aneurysms, as well as the importance of core lab adjudication in assessing outcomes in such a trial.

Endovascular Treatment of Middle Cerebral Artery Aneurysms

Neurosurgery ◽  
2011 ◽  
Vol 68 (2) ◽  
pp. 397-402 ◽  
Author(s):  
Waleed Brinjikji ◽  
Giuseppe Lanzino ◽  
Harry J. Cloft ◽  
Alejandro Rabinstein ◽  
David F. Kallmes
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Case Series ◽  
Endovascular Coiling ◽  
Consecutive Case ◽  
Treatment Rate ◽  
Mortality And Morbidity ◽  
Ruptured Aneurysms

Abstract BACKGROUND: Middle cerebral artery (MCA) aneurysms are often considered unsuitable for endovascular coiling because of unfavorable morphological features. With improvements in endovascular techniques, several series have detailed the results and complications of endovascular treatment of MCA aneurysms. OBJECTIVE: We performed a systematic review of published series on endovascular treatment of MCA aneurysms including our experience. METHODS: We conducted a computerized MEDLINE search of the literature on endovascular treatment of MCA aneurysms. Only studies examining a consecutive case series of MCA aneurysms were included. We then extracted information regarding intraprocedural complications, procedural mortality and morbidity, immediate and long-term angiographic outcomes, and re-treatment rate. Analysis was done including 40 MCA aneurysms treated at our institution. RESULTS: Twelve studies including our institution's consecutive case series were included. Approximately 50% of the aneurysms presented as ruptured. Intraprocedural rupture rate in unruptured aneurysms was 1.7% (95% confidence interval [CI] = 0.7%-3.6%) compared with 4.8% (95% CI = 3.1%-7.4%) for ruptured aneurysms (P = .02). The risk of early postprocedural hemorrhage was 1.1% (95% CI = 0.5%-2.5%) for ruptured aneurysms. Overall procedure-related permanent morbidity and mortality were 5.1% and 6.0% for unruptured and ruptured aneurysms, respectively. The overall rate of complete or near-complete obliteration at angiographic follow-up was 82.4%. CONCLUSION: Endovascular treatment of MCA aneurysms is feasible and effective in selected cases. The combined periprocedural mortality and morbidity is not negligible (5.1%) and the overall rate of complete or near-complete angiographic obliteration at follow-up approaches 82%.

One-year Angiographic Results After pCONus Stent-Assisted Coiling of 40 Wide-Neck Middle Cerebral Artery Aneurysms

Neurosurgery ◽  
2017 ◽  
Vol 80 (6) ◽  
pp. 925-933 ◽  
Author(s):  
Benjamin Gory ◽  
Marta Aguilar-Pérez ◽  
Elisa Pomero ◽  
Francis Turjman ◽  
Werner Weber ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Endovascular Coiling ◽  
Total Occlusion ◽  
Complete Occlusion ◽  
Neck Size ◽  
Clinical Complications ◽  
Middle Cerebral Artery Aneurysms ◽  
Wide Neck

Abstract BACKGROUND: Bifurcation middle cerebral artery (MCA) aneurysms with wide neck are amenable to endovascular coiling with pCONus stent, a recent device dedicated to wide-neck bifurcation intracranial aneurysms. OBJECTIVE: To evaluate the 1-year angiographic follow-up of wide-neck MCA aneurysms treated with pCONus. METHODS: Forty MCA aneurysms (mean dome size, 7.7 mm; mean neck size, 5.6 mm) coiled with pCONus were retrospectively evaluated. “Recanalization” was defined as worsening, and “progressive thrombosis” was defined as improvement on the Raymond scale. RESULTS: Angiographic midterm (mean, 11.9 months; range, 3-20) follow-up was obtained in all aneurysms. Retreatment was performed in 9 aneurysms (22.5%) without clinical complications, and postoperative angiographic outcome included 2 complete occlusions and 7 neck remnants. Six aneurysms were followed after retreatment (mean, 8.8 months), and presented complete occlusion in 1 case, neck remnant in 4 cases, and aneurysm remnant in 1 case. Among the 31 aneurysms, follow-up showed complete occlusion in 67.7% (21/31), neck remnants in 29% (9/31), and aneurysm remnants in 3.3% (1/31). Adequate aneurysm occlusion (total occlusion and neck remnant) was obtained in 96.7% (30/31). Among these 31 aneurysms, improvement of the rate of occlusion was observed in 15 aneurysms (48.4%), and recurrence in 2 aneurysms (6.5%). There was no 1-year angiographic recurrence of 3- or 6-month totally occluded aneurysms. CONCLUSION: pCONus stent allows a safe coiling of wide-neck MCA aneurysms usually considered as surgical with a low recanalization rate for those adequately occluded at 3 to 6 months. Angiographic results improve over time due to progressive aneurysm thrombosis in around 50% of cases.

Reinforcement with gauze wrapping for ruptured aneurysms of the middle cerebral artery

1977 ◽  
Vol 47 (6) ◽  
pp. 828-832 ◽  
Author(s):  
Julien C. Taylor ◽  
Abdur R. Choudhury
Keyword(s):  
Mortality Rate ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Recurrent Hemorrhage ◽  
Content Type ◽  
Mortality And Morbidity ◽  
Ruptured Aneurysms ◽  
Follow Up Study ◽  
Fine Print

✓ A 2- to 15-year follow-up study is presented of a series of 35 consecutive patients treated for ruptured aneurysms of the middle cerebral artery by reinforcement with gauze wrapping. Only one patient suffered early recurrent hemorrhage in the postoperative period, and none had a late hemorrhage. The procedure carried a relatively low mortality rate (8.6%). Morbidity was the direct sequel of preoperative conditions. Wrapping is an effective and safe treatment of these aneurysms, with a low mortality and morbidity, and freedom from occlusive infarcts.

Endovascular WEB Flow Disruption in Middle Cerebral Artery Aneurysms

Neurosurgery ◽  
2013 ◽  
Vol 73 (1) ◽  
pp. 27-35 ◽  
Author(s):  
Laurent Pierot ◽  
Joachim Klisch ◽  
Christophe Cognard ◽  
Istvan Szikora ◽  
Benjamin Mine ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Preliminary Treatment ◽  
Short Term ◽  
Total Occlusion ◽  
Flow Disruption ◽  
Wide Neck ◽  
The Web

Abstract BACKGROUND: The endovascular treatment of middle cerebral artery (MCA) aneurysms with unfavorable anatomy (wide neck, unfavorable morphology) is frequently challenging. Flow disruption with the WEB is a potentially interesting endovascular treatment for this type of aneurysm. OBJECTIVE: To report in a multicenter series the preliminary treatment experience of MCA aneurysms with flow disruption by the WEB. METHODS: Thirty-three patients with 34 MCA aneurysms were treated with the WEB in 5 European centers. The ability to successfully deploy the WEB, procedure- and device-related adverse events, morbidity and mortality of the treatment, and short-term angiographic follow-up results were analyzed. RESULTS: Most treated aneurysms were unruptured (85.3%) and were between 5 and 10 mm (85.3%) with a neck size ≥ 4 mm (88.2%). The treatment failed in 1 of the 34 aneurysms (2.9%) owing to a lack of appropriate device size. Treatment was performed exclusively with the WEB in 29 of 33 aneurysms (87.9%). Additional treatment (coiling and/or stenting) was used in 4 of 33 aneurysms (12.1%). Mortality of the treatment was 0.0% and morbidity was 3.1% (intraoperative rupture with modified Rankin Scale score of 3 at the 1-month follow-up). In short-term follow-up (range, 2-12 months), adequate occlusion (total occlusion or neck remnant) was observed in 83.3% of aneurysms. CONCLUSION: WEB flow disruption seems to be a promising technique for the treatment of complex MCA aneurysms, particularly those with a wide neck or unfavorable dome-to-neck ratio.

Open and Endovascular Treatment of Unruptured Carotid-Ophthalmic Aneurysms: Clinical and Radiographic Outcomes

Neurosurgery ◽  
2011 ◽  
Vol 68 (5) ◽  
pp. 1434-1443 ◽  
Author(s):  
Sanjay Yadla ◽  
Peter G. Campbell ◽  
Bartosz Grobelny ◽  
Jack Jallo ◽  
L. Fernando Gonzalez ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Combined Treatment ◽  
Combined Modality Treatment ◽  
Endovascular Techniques ◽  
Patient Demographics ◽  
Radiographic Outcomes ◽  
Major Complications ◽  
Initial Procedure ◽  
Elective Setting

Abstract BACKGROUND: Aneurysms of the carotid-ophthalmic artery present unique challenges to cerebrovascular neurosurgeons given their proximity to vital anatomic structures. OBJECTIVE: To report our experience with a combined-modality treatment of unruptured carotid-ophthalmic aneurysms over a 12-year period. METHODS: A retrospective review of 161 patients who underwent open, endovascular, or combined treatment of 170 aneurysms from January 1997 to July 2009 was conducted. Medical records, operative reports, office notes, and follow-up angiograms were reviewed to obtain data on patient demographics, angiographic results, and clinical outcomes. RESULTS: One hundred forty-seven aneurysms were treated via endovascular techniques; 17 aneurysms (10%) were treated with microsurgical clip ligation; and 6 aneurysms (3.5%) were treated with a combined approach. Of the aneurysms treated via an endovascular approach alone, 81.6% of aneurysms had evidence of ≥ 95% occlusion on initial angiogram. There was a 1.4% rate of major complications associated with the initial procedure. Twenty-six of these aneurysms (18.9%) required further intervention on the basis of early angiographic results. Major complications occurred after 6 of 23 open microsurgical procedures (26.1%), including 2 instances of permanent visual loss. Nine clipped patients had long-term angiographic follow-up; none required further intervention. CONCLUSION: Endovascular treatment of carotid-ophthalmic aneurysms with modern endovascular techniques can be performed safely and efficaciously in the elective setting.

scholarly journals Balloon-expandable stents for treatment of symptomatic middle cerebral artery stenosis: Clinical outcomes during long-term follow-up

2018 ◽  
Vol 24 (6) ◽  
pp. 666-673 ◽  
Author(s):  
Sung Hyun Baik ◽  
Hyo Sung Kwak ◽  
Gyung Ho Chung ◽  
Seung Bae Hwang
Keyword(s):  
Middle Cerebral Artery ◽  
Clinical Outcomes ◽  
Cerebral Artery ◽  
Reperfusion Therapy ◽  
Stent Insertion ◽  
Recurrence Rates ◽  
Long Term Follow Up ◽  
Ischemic Events

Background Insertion of a balloon-expandable stent (BES) in patients with symptomatic intracranial atherosclerosis is a treatment option for reperfusion therapy. In this study, we retrospectively reviewed clinical outcomes during long-term follow-up after insertion of balloon-expandable stents in patients with symptomatic middle cerebral artery (MCA) stenosis. Methods Institutional review board approval was obtained for retrospective review of patient data. Thirty-four patients (15 men, 19 women; median age, 67.5 years) with symptomatic MCA stenosis underwent balloon-expandable stent insertion between June 2008 and December 2010. Patient records were reviewed for angiographic findings and clinical outcomes during long-term follow-up. Results Of these patients, 22 presented with acute ischemic stroke with underlying MCA atherosclerosis and had good clinical outcomes (modified Rankin Scale score (mRS): 0–2) after reperfusion therapy. Indications for stenting for the remaining 12 patients were recurrent transient ischemic attacks (TIAs) refractory to medical therapy and MCA stenosis greater than 70%. During the poststenting follow-up period, which ranged from 61 to 108 months (median, 67.5 months), a TIA occurred in five patients. Of these five patients, one experienced a complete reocclusion of the MCA stent, and three had symptomatic restenosis. The remaining 29 patients did not experience any further ischemic events or restenosis during the follow-up period. Conclusions In our study, treatment with balloon-expandable stents in patients with symptomatic MCA stenosis resulted in low recurrence rates for both ischemic events and restenosis during long-term follow-up.

Republished: Endovascular recanalisation with drug coated balloon for chronic symptomatic middle cerebral artery total occlusion

2018 ◽  
Vol 10 (9) ◽  
pp. e24-e24 ◽  
Author(s):  
Jun Zhang ◽  
Xiao Zhang ◽  
Jin-Ping Zhang ◽  
Ju Han
Keyword(s):  
Middle Cerebral Artery ◽  
Medical Therapy ◽  
Cerebral Artery ◽  
De Novo ◽  
Total Occlusion ◽  
Good Outcome ◽  
Stent Restenosis ◽  
Drug Coated Balloon ◽  
In Stent Restenosis

The optimal treatment for patients with chronic symptomatic middle cerebral artery (MCA) total occlusion is not well established. In addition to medical therapy, vessel recanalisation with stenting has shown much promise, especially for patients with recurrent ischemic symptoms. Nevertheless, the incidence of symptomatic in-stent restenosis (ISR) is high, and is associated with an unfavorable prognosis. Drug coated balloons (DCBs) have been proven to be effective in treating and preventing ISR. However, the feasibility of DCBs for de novo intracranial atherothrombotic stenosis has not been previously described, especially for total occlusion lesions. Here we reported a patient with chronic left MCA total occlusion successfully treated with DCBs, with a good outcome at the 1 year follow-up. More studies are warranted to further compare the efficacy of DCBs and stentings for intracranial revascularisation.

scholarly journals Pipeline-assisted coil embolization of a large middle cerebral artery pseudoaneurysm in a 9-month-old infant: experience from the youngest flow diversion case

2018 ◽  
Vol 22 (5) ◽  
pp. 532-540 ◽  
Author(s):  
Geoffrey P. Colby ◽  
Bowen Jiang ◽  
Matthew T. Bender ◽  
Narlin B. Beaty ◽  
Erick M. Westbroek ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Pediatric Population ◽  
Flow Diversion ◽  
Left Middle Cerebral Artery ◽  
Artery Pseudoaneurysm ◽  
First Case ◽  
Aneurysm Occlusion

Intracranial aneurysms in the pediatric population are rare entities. The authors recently treated a 9-month-old infant with a 19-mm recurrent, previously ruptured, and coil-embolized left middle cerebral artery (MCA) pseudoaneurysm, which was treated definitively with single-stage Pipeline-assisted coil embolization. The patient was 5 months old when she underwent resection of a left temporal Grade 1 desmoplastic infantile ganglioglioma at an outside institution, which was complicated by left MCA injury with a resultant 9-mm left M1 pseudoaneurysm. Within a month, the patient had two aneurysmal rupture events and underwent emergency craniectomy for decompression and evacuation of subdural hematoma. The pseudoaneurysm initially underwent coil embolization; however, follow-up MR angiography (MRA) revealed aneurysm recanalization with saccular enlargement to 19 mm. The patient underwent successful flow diversion–assisted coil embolization at 9 months of age. At 7 months after the procedure, follow-up MRA showed complete aneurysm occlusion without evidence of in-stent thrombosis or stenosis. Experience with flow diverters in the pediatric population is still in its early phases, with the youngest reported patient being 22 months old. In this paper the authors report the first case of such a technique in an infant, whom they believe to be the youngest patient to undergo cerebral flow diversion treatment.

scholarly journals Long-term results of middle cerebral artery aneurysm clipping in the Barrow Ruptured Aneurysm Trial

2019 ◽  
Vol 130 (3) ◽  
pp. 895-901 ◽  
Author(s):  
Michael A. Mooney ◽  
Elias D. Simon ◽  
Scott Brigeman ◽  
Peter Nakaji ◽  
Joseph M. Zabramski ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Clinical Outcomes ◽  
Cerebral Artery ◽  
Long Term Results ◽  
Ruptured Aneurysm ◽  
Microsurgical Clipping ◽  
Mca Aneurysm

OBJECTIVEA direct comparison of endovascular versus microsurgical treatment of ruptured middle cerebral artery (MCA) aneurysms in randomized trials is lacking. As endovascular treatment strategies continue to evolve, the number of reports of endovascular treatment of these lesions is increasing. Herein, the authors report a detailed post hoc analysis of ruptured MCA aneurysms treated by microsurgical clipping from the Barrow Ruptured Aneurysm Trial (BRAT).METHODSThe cases of patients enrolled in the BRAT who underwent microsurgical clipping for a ruptured MCA aneurysm were reviewed. Characteristics of patients and their clinical outcomes and long-term angiographic results were analyzed.RESULTSFifty patients underwent microsurgical clipping of a ruptured MCA aneurysm in the BRAT, including 21 who crossed over from the endovascular treatment arm. Four patients with nonsaccular (e.g., dissecting, fusiform, or blister) aneurysms were excluded, leaving 46 patients for analysis. Most (n = 32; 70%) patients presented with a Hunt and Hess grade II or III subarachnoid hemorrhage, with a high prevalence of intraparenchymal blood (n = 23; 50%), intraventricular blood (n = 21; 46%), or both. At the last follow-up (up to 6 years after treatment), clinical outcomes were good (modified Rankin Scale score 0–2) in 70% (n = 19) of 27 Hunt and Hess grades I–III patients and in 36% (n = 4) of 11 Hunt and Hess grade IV or V patients. There were no instances of rebleeding after the surgical clipping of aneurysms in this series at the time of last clinical follow-up.CONCLUSIONSMicrosurgical clipping of ruptured MCA aneurysms has several advantages over endovascular treatment, including durability over time. The authors report detailed outcome data of patients with ruptured MCA aneurysms who underwent microsurgical clipping as part of a prospective, randomized trial. These results should be used for comparison with future endovascular and surgical series to ensure that the best results are being achieved for patients with ruptured MCA aneurysms.

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