Endovascular coil occlusion of 152 middle cerebral artery aneurysms: initial and midterm angiographic and clinical results

2010 ◽  
Vol 112 (4) ◽  
pp. 703-708 ◽  
Author(s):  
Serge Bracard ◽  
Amr Abdel-Kerim ◽  
Lorrena Thuillier ◽  
Olivier Klein ◽  
René Anxionnat ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Vegetative State ◽  
Clinical Results ◽  
Endovascular Coiling ◽  
Consecutive Series ◽  
Unruptured Aneurysms ◽  
Coil Occlusion

Object The object of this study was to evaluate the initial and mid-term angiographic and clinical results after endovascular coil occlusion of middle cerebral artery (MCA) aneurysms at the authors' institution. Methods The authors conducted a retrospective analysis of a consecutive series of 152 MCA aneurysms (73 ruptured) treated by endovascular coiling in 140 patients. Angiographic and clinical data at initial and midterm follow-up as well as procedure-related complications were prospectively registered. Results At discharge, favorable clinical outcomes (Glasgow Outcome Scale score of 1 or 2) were obtained in 89.3% of patients (125/140). Seven patients (5%) were in a vegetative state or had died. Complications were encountered in association with 11.8% of the procedures (18/152), and most (13/18) involved thromboembolic events (which led to permanent ischemia in 4 cases and death in 1). The overall procedure-related mortality rate was 0.7%, and the rates of permanent and transient morbidity were 2.6 and 2%, respectively. At a mean follow-up duration of 4.3 years there had been 4 cases of rebleeding: early rebleeding occurred during the initial postoperative period in 3 cases and later in 1. Total or subtotal occlusion was obtained in 84.2% of aneurysms (128/152). At follow-up, this satisfactory occlusion persisted in 83.3% of aneurysms (110/132) at 1 year posttreatment, 79.5% (89/112) at 3 years, and 80.2% (73/91) at 5 years. Conclusions Risks and initial and midterm angiographic and clinical results after endovascular treatment of MCA aneurysms are nearly identical to other locations. Endovascular treatment may thus be proposed as an alternative to surgical clipping at this location. Nevertheless, a longer follow-up period is necessary to determine its efficacy, particularly in cases of unruptured aneurysms.

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%.

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.

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.

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.

Endovascular treatment of acutely ruptured and unruptured aneurysms of the basilar bifurcation

1997 ◽  
Vol 86 (2) ◽  
pp. 211-219 ◽  
Author(s):  
Jean Raymond ◽  
Daniel Roy ◽  
Michel Bojanowski ◽  
Robert Moumdjian ◽  
Georges L'Espérance
Keyword(s):  
Endovascular Treatment ◽  
Clinical Results ◽  
Aneurysm Rupture ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Complete Obliteration ◽  
Clinically Significant ◽  
Technical Complication ◽  
Fine Print

✓ The surgical treatment of basilar bifurcation aneurysms is difficult and the need for an alternative approach is frequently stated. To assess the efficacy and safety of endovascular treatment of aneurysms located at the basilar bifurcation, the authors prospectively studied angiographic results, clinical results, and complications in 31 patients treated with Guglielmi detachable coils (GDCs). Patients treated acutely after subarachnoid hemorrhage (SAH) were graded according to the Hunt and Hess classification and clinical outcome was determined at 1- and 6-month intervals according to the Glasgow Outcome Scale (GOS). There were 18 women and 13 men, ranging in age from 34 to 67 years (mean age 48 years). Twenty-three were treated acutely after SAH. Clinical Hunt and Hess grades at presentation were as follows: Grade I, six patients; Grade II, three; Grade III, 11; Grade IV, two; and Grade V, one. The GOS score for the group of patients treated acutely was: GOS I, 18 patients; GOS II, III, and IV, one patient each; and GOS V, two patients. There were seven technical complications in this group, most often asymptomatic, but one patient died after aneurysm rupture during treatment and one had residual diplopia at 4 months. Eight patients were treated for incidental basilar bifurcation aneurysms. One technical complication with no neurological deficit occurred in this group of patients with incidental aneurysms. Immediate angiographic results were considered to be satisfactory in 94% of patients, with complete obliteration in 42% and residual neck and dog ears in 52%. There was no bleeding episode after treatment during clinical follow-up periods ranging from 3 to 42 months (mean 15.5 months in 29 surviving patients). Angiographic results were available for 27 patients at 6 months and were as follows: 30% of the lesions were completely obliterated, 59% presented some residual neck, and 11% showed some opacification of the aneurysm sac. During the follow-up period of up to 42 months, a total of seven recurrences were noted, necessitating retreatment with GDCs in five patients. Endovascular treatment of basilar bifurcation aneurysms prevented rebleeding and could be performed without clinically significant complications in 94% of patients. Clinical results after SAH compared favorably with surgical series. Morphological results appear less satisfactory, and long-term angiographic follow-up review is mandatory to detect recurrences.

scholarly journals Non Ruptured MCA Aneurysms Presenting with Insular Related Symptoms

2010 ◽  
Vol 37 (2) ◽  
pp. 219-222 ◽  
Author(s):  
Ramez Malak ◽  
Dank Khoa Nguyen ◽  
Michel W. Bojanowski
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Surgical Approach ◽  
Complete Resolution ◽  
Endovascular Coiling ◽  
Autonomic Symptoms ◽  
Unruptured Aneurysms ◽  
The Third

Objective:To present a new semiological description of unruptured middle cerebral artery (MCA) aneurysms.Methods:We present a series of three MCA aneurysms presenting with progressive or paroxystic somatosensory symptoms in combination with visceral, motor, language or autonomic symptoms.Results:A surgical approach was proposed for two aneurysms, and both patients experienced complete resolution of their symptoms. The third aneurysm was successfully excluded by endovascular coiling but the symptoms persisted.Conclusions:To our knowledge this is the first description of unruptured aneurysms presenting with insular-related symptoms.

scholarly journals Remote results of endovascular treatment of middle cerebral artery aneurysms

2015 ◽  
Vol 17 (2) ◽  
pp. 28
Author(s):  
D. V. Shcheglov
Keyword(s):  
Postoperative Complications ◽  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Considerable Increase ◽  
Mass Effect ◽  
Endovascular Occlusion ◽  
Middle Cerebral Artery Aneurysms

Our objective was to study the dynamics of remote results of MCA SA endovascular occlusion. 149 patients with MCA SA were examined and operated, 127 patients were selected for 36 months follow-up, 112 patients in 1 year follow-up, 52 patients were to be examined in 23 years, 17 in 45 years and 14 patients in more than 5 years. Endovascular occlusion was carried out by means of different coils during reconstructive 138 (92.6%) and unplanned deconstructive occlusions 8 (5.4%). For planned deconstructions detachable balloons were used 3 (2%). 17 (11.4%) recurrences were diagnosed and 12 (8%) repeated operations were performed. 19 (12.8%) intra-and postoperative complications/ predictors and 18 (12.1%) complications unrelated to surgery were observed in the first 30 days and only 1 (1.1%) mass effect was identified in 36 months. After our research we were ableto trackthe dynamicsof thepatientslife quality according totheRankinscale; tomonitorthe changes in SA occlusion degree; to define the frequency of recurrences and complications/predictors of complications and to determine the amount of reoperations. We noted a considerable increase in the quantity of total occlusions after reoperations, which resulted in much better filling of the CA cavity, because the prophylaxis of the repeated hemorrhages is the main goal of SA endovascular treatment.

Angiographic and Clinical Results after Endovascular Treatment for Middle Cerebral Artery Berry Aneurysms

2007 ◽  
Vol 20 (1) ◽  
pp. 89-101 ◽  
Author(s):  
N. Hirota ◽  
M. Musacchio ◽  
M. Cardoso ◽  
F. Villarejo ◽  
C. Requelme ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Clinical Results

Endovascular Treatment of 174 Middle Cerebral Artery Aneurysms: Clinical Outcome and Radiologic Results at Long-term Follow-up

Radiology ◽  
2009 ◽  
Vol 253 (1) ◽  
pp. 191-198 ◽  
Author(s):  
Jean-François Vendrell ◽  
Nicolas Menjot ◽  
Vincent Costalat ◽  
Denis Hoa ◽  
Jorge Moritz ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Long Term Follow Up ◽  
Middle Cerebral Artery Aneurysms

Abstract T P34: Residual Contrast Enhancement of Middle Cerebral Artery on Non-contrast Ct (ncct) After Endovascular Treatment in Ischemic Stroke Patients

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Seyedmehdi Payabvash ◽  
Mushtaq H Qureshi ◽  
Shahram Majidi ◽  
Adnan I Qureshi
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Contrast Enhancement ◽  
Cerebral Artery ◽  
Interquartile Range ◽  
Time Interval ◽  
Contrast Ct

Background: Residual contrast enhancement of cerebral arteries is frequently visualized on follow up non-contrast CT (NCCT) after endovascular treatment in acute ischemic stroke and may represent distal microvascular no-reflow phenomenon. Objective: To evaluated the prevalence of and correlation between post- endovascular treatment residual contrast enhancement of middle cerebral artery (MCA) on follow up NCCT with clinical and imaging outcomes in patients with acute ischemic stroke. Methods: We analyzed clinical and radiographic data from all patients with acute MCA occlusion who underwent endovascular treatment at two centers over a 6-year period. The M1 segment of affected MCA was selected with free-hand region of interest on the first post-angiography NCCT; and the average attenuation was determined in Hounsfield units (HU). Bivariate correlation between the MCA contrast enhancement and clinical/imaging outcome was determined. Results: A total of 89 patients (mean age ± SD, 66.4 ± 15.5 years) with MCA occlusion were included. The median time interval between the first follow up NCCT and the time of catheterization, and the time of recanalization (if successful) were 1.7 h (interquartile range: 1.2 - 2.4), and 0.8 h (interquartile range: 0.5 - 1.6), respectively. MCA contrast enhancement with an average attenuation of >40 HU was seen in 74 of 89 patients. There was no significant correlation between the average attenuation of the affected MCA on post- endovascular treatment NCCT and post- endovascular treatment “Thrombolysis in Cerebral Infarction” (TICI) score (p=0.43), Qureshi score (p=0.61), discharge National Institutes of Health Stroke Scale (NIHSS) score (p=0.34), or 3-month modified Rankin score (p=0.51). However, the MCA contrast enhancement was inversely correlated with time interval between NCCT and catheterization (p<0.001) and angiographic recanalization (p<0.001). Conclusion: In patients with acute ischemic stroke, the residual contrast enhancement of the affected MCA on NCCT post- endovascular treatment does not correlate with status of recanalization or clinical outcome.

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