Endovascular Treatment of Wide-Neck Middle Cerebral Artery Aneurysms with Stents: A Review of 16 Cases

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.

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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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Remote results of endovascular treatment of middle cerebral artery aneurysms

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2013-3-28-33 ◽

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.

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Endovascular treatment of middle cerebral artery aneurysms – single-centre results

Polish Journal of Radiology ◽

10.5114/pjr.2020.103204 ◽

2020 ◽

Vol 85 (1) ◽

pp. 650-656

Author(s):

Paweł Brzegowy ◽

Jakub Polak ◽

Jakub Wnuk ◽

Bartłomiej Łasocha ◽

Borys Kwinta ◽

...

Keyword(s):

Endovascular Treatment ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Single Centre ◽

Middle Cerebral Artery Aneurysms

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E-026 Thromboembolic complications in endovascular treatment of middle cerebral artery aneurysms

10.1136/neurintsurg-2017-snis.98 ◽

2017 ◽

Author(s):

T Link ◽

S Boddu ◽

N Lin ◽

P Gobin ◽

J Knopman ◽

...

Keyword(s):

Endovascular Treatment ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Thromboembolic Complications ◽

Middle Cerebral Artery Aneurysms

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

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2014-011460 ◽

2015 ◽

Vol 8 (3) ◽

pp. 287-294 ◽

Cited By ~ 49

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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