Distal Middle Cerebral Artery Aneurysms

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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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.

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A Combined Approach to Treatment of the Dissecting Middle Cerebral Artery Fusiform Aneurysm

Interventional Neuroradiology ◽

10.1177/159101990901500314 ◽

2009 ◽

Vol 15 (3) ◽

pp. 349-354 ◽

Cited By ~ 3

Author(s):

T. Hrbáč ◽

P. Drábek ◽

P. Klement ◽

V. Procházka

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Artery Occlusion ◽

Parent Artery ◽

Fusiform Aneurysm ◽

Neurological Sequelae ◽

Parent Artery Occlusion ◽

Aneurysm Embolization ◽

Mca Aneurysm ◽

One Year

A fusiform aneurysm in the terminal M1 middle cerebral artery (MCA) segment was treated by a construction of a high-flow arterial extracranial-intracranial (EC-IC) bypass. Due to severe bypass vasospasms, local vasodilating agents together with percutaneous angioplasty and stent implantation were applied, but failed due to subsequent bypass occlusion. To remedy this complication a new bypass was created from a segment of the saphenous vein, followed by MCA aneurysm embolization and parent artery occlusion. One year after the surgery, the venous bypass remains patent and the aneurysm occluded, with the patient fully active, without any neurological sequelae.

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Stent-assisted coil embolization of unruptured middle cerebral artery aneurysms using LVIS Jr. stents

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2020.07.070 ◽

2020 ◽

Vol 80 ◽

pp. 87-91

Author(s):

Hidenori Oishi ◽

Takashi Fujii ◽

Kenji Yatomi ◽

Kohsuke Teranishi ◽

Kazumoto Suzuki ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Coil Embolization ◽

Middle Cerebral Artery Aneurysms

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Elective Treatment of Saccular and Broad-necked Intracranial Aneurysms using a Closed-cell Nitinol Stent (Leo)

Neurosurgery ◽

10.1227/01.neu.0000197103.10364.0c ◽

2006 ◽

Vol 58 (3) ◽

pp. 443-450 ◽

Cited By ~ 64

Author(s):

Bernhard Kis ◽

Werner Weber ◽

Peter Berlit ◽

Dietmar Kühne

Keyword(s):

Carotid Artery ◽

Cerebral Artery ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Neurological Deficits ◽

Long Term Results ◽

Parent Artery ◽

Stent Deployment ◽

Parent Artery Occlusion

Abstract OBJECTIVE: Endovascular coil embolization of saccular intracranial aneurysms is safe and effective, but long-term results are dissatisfying. Reconstructive treatments using stents improve occlusion rate and protect parent vessels. We present data on our experience with a new self-expanding stent manufactured with braided nitinol wires. METHODS: Twenty-five saccular, complex, and broad-necked intracranial aneurysms in 21 patients were treated electively. They were located at the internal carotid artery (10), basilar trunk (5), cavernous carotid artery (4), basilar tip (2), anterior cerebral artery (2), anterior communicating artery (1), and middle cerebral artery (1). Eleven aneurysms exhibited recanalization after primary endovascular treatment without stent. RESULTS: Stent deployment was successful in 24 lesions, and additional coil embolization was performed in 23. No permanent neurological deficits were encountered consequent to endovascular procedure. Complete or partial occlusion immediately after stent deployment was achieved in 19 aneurysms, whereas no immediate coil embolization was chosen in 6 cases. There were two thromboembolic events related to the deployment of the Leo stent, one failure of stent deployment, difficulties in stent positioning in three cases, and one asymptomatic parent artery occlusion after 7 months. Follow-up (available in 18 patients and 21 aneurysms and obtained at 3–12 mo; average, 5 mo) revealed patent stents in the remaining cases. Angiographic recurrences arose in three lesions, which were retreated without complications. CONCLUSION: Primary and recurrence treatment of saccular and broad-necked intracranial aneurysms using the Leo stent is feasible and effective. No permanent neurological deficits were associated with stent placement. Short-term follow-up identified intact parent arteries and stable occlusion rates in the majority of cases.

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Endovascular coil embolization of middle cerebral artery aneurysms of the proximal (M1) segment

Neuroradiology ◽

10.1007/s00234-013-1190-5 ◽

2013 ◽

Vol 55 (9) ◽

pp. 1097-1102 ◽

Cited By ~ 25

Author(s):

Young Dae Cho ◽

Woong Jae Lee ◽

Kang Min Kim ◽

Hyun-Seung Kang ◽

Jeong Eun Kim ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Coil Embolization ◽

Endovascular Coil Embolization ◽

Middle Cerebral Artery Aneurysms

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Microcatheter Looping Technique for Coil Embolization of Complex Configuration Middle Cerebral Artery Aneurysms

Neurosurgery ◽

10.1227/neu.0b013e318271ee1a ◽

2012 ◽

Vol 71 (6) ◽

pp. 1185-1191 ◽

Cited By ~ 18

Author(s):

Young Dae Cho ◽

Hyun-Seung Kang ◽

Jeong Eun Kim ◽

Young Je Son ◽

Jong Young Lee ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Coil Embolization ◽

Complex Configuration ◽

Distal Branch ◽

Branch Vessel ◽

Middle Cerebral Artery Aneurysms ◽

Wide Neck

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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