Endovascular Recanalization of Non-acute Symptomatic Middle Cerebral Artery Total Occlusion and Its Short-Term Outcomes

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.

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Endovascular recanalization for chronic symptomatic middle cerebral artery total occlusion

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2012-010304 ◽

2012 ◽

Vol 5 (3) ◽

pp. e15-e15 ◽

Cited By ~ 12

Author(s):

Ning Ma ◽

Da-Peng Mo ◽

Feng Gao ◽

Zhong-Rong Miao

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Total Occlusion ◽

Endovascular Recanalization

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Successful endovascular recanalization of acute accessory middle cerebral artery occlusion; A case report and literature review

Interdisciplinary Neurosurgery ◽

10.1016/j.inat.2021.101351 ◽

2021 ◽

Vol 26 ◽

pp. 101351

Author(s):

Shogo Shima ◽

Shinsuke Sato ◽

Keisuke Yoshida ◽

Yoshikazu Okada ◽

Yasunari Niimi

Keyword(s):

Case Report ◽

Literature Review ◽

Middle Cerebral Artery ◽

Middle Cerebral Artery Occlusion ◽

Cerebral Artery ◽

Artery Occlusion ◽

Endovascular Recanalization ◽

Accessory Middle Cerebral Artery ◽

Cerebral Artery Occlusion

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

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2017-013693.rep ◽

2018 ◽

Vol 10 (9) ◽

pp. e24-e24 ◽

Cited By ~ 2

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.

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The role of PI3K-mediated AMPA receptor changes in post-conditioning of propofol in brain protection

BMC Neuroscience ◽

10.1186/s12868-019-0532-6 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Chenxu Wang ◽

Ying Wei ◽

Yuan Yuan ◽

Yonghao Yu ◽

Keliang Xie ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Middle Cerebral Artery Occlusion ◽

Cerebral Artery ◽

Ischemia Reperfusion ◽

Artery Occlusion ◽

Sham Operation ◽

Short Term ◽

Selective Antagonist ◽

Cerebral Artery Occlusion

Abstract Background We aimed to study the role of amino-3-hydroxy-5-methylisoxazole-4-propionic acid receptor (AMPAR) glutamate receptor 2 (GluR2) subunit trafficking, and activity changes in short-term neuroprotection provided by propofol post-conditioning. We also aimed to determine the role of phosphoinositide-3-kinase (PI3K) in the regulation of these processes. Methods Rats underwent 1 h of focal cerebral ischemia followed by 23 h of reperfusion were randomly divided into 6 groups (n = 36 per group): sham- operation (S), ischemia–reperfusion (IR), propofol (P group, propofol 20 mg/kg/h at the onset of reperfusion for 2 h after 60 min of occlusion), and LY294002 (PI3K non-selective antagonist) + sham (L + S, LY294002 of 1.5 mg/kg was infused 30 min before sham operation), LY294002+ ischemia–reperfusion (L + IR, LY294002 of 1.5 mg/kg was infused 30 min before middle cerebral artery occlusion), LY294002 + IR + propofol (L + P, LY294002 of 1.5 mg/kg was infused 30 min before middle cerebral artery occlusion and propofol 20 mg/kg/h at the onset of reperfusion for 2 h after 60 min of occlusion). Results Compared with group IR, rats in group P had significant lower neurologic defect scores and infarct volume. Additionally, consistent with enhanced expression of PI3K-AMPAR GluR2 subunit complex substances in ipsilateral hippocampus, GluR2 subunits showed increased levels in both the plasma and postsynaptic membranes of neurons, while pGluR2 expression was reduced in group P. Furthermore, LY294002, the PI3K non-selective antagonist, blocked those effects. Conclusion These observations demonstrated that propofol post-conditioning revealed acute neuroprotective role against transient MCAO in rats. The short-term neuroprotective effect was contributed by enhanced GluR2 subunits trafficking to membrane and postsynaptic membranes of neurons, as well as down-regulated the expression of pGluR2 in damaged hippocampus. Finally, the above-mentioned protective mechanism might be contributed by increased combination of PI3K to AMPAR GluR2 subunit, thus maintained the expression and activation of AMPAR GluR2 in the ipsilateral hippocampus.

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

Neurosurgery ◽

10.1093/neuros/nyw131 ◽

2017 ◽

Vol 80 (6) ◽

pp. 925-933 ◽

Cited By ~ 21

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.

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