scholarly journals Rescue endovascular treatment for rapid regrowth of aneurysm remnant on middle cerebral artery trunk after unsuccessful surgical clipping in patients with a ruptured cerebral aneurysm: A report of two cases

2020 ◽  
Author(s):  
Hyun Wook Cho ◽  
Donghwan Jang ◽  
Hyo Sub Jun
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Aneurysm ◽  
Cerebral Artery ◽  
Surgical Clipping ◽  
Rapid Regrowth

ENDOVASCULAR TREATMENT OF MIDDLE CEREBRAL ARTERY ANEURYSMS WITH DETACHABLE COILS

Neurosurgery ◽  
2009 ◽  
Vol 64 (5) ◽  
pp. 876-889 ◽  
Author(s):  
Shuichi Suzuki ◽  
Satoshi Tateshima ◽  
Reza Jahan ◽  
Gary R. Duckwiler ◽  
Yuichi Murayama ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Bypass Surgery ◽  
Combined Treatment ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Surgical Clipping ◽  
Endovascular Coil Embolization

Abstract OBJECTIVE Because of their anatomic configuration, middle cerebral artery (MCA) aneurysms are most often treated with surgical clipping. However, endovascular coil embolization of these aneurysms is an increasingly used alternative. We retrospectively reviewed the anatomic and clinical outcomes of patients with MCA aneurysms who underwent endovascular treatment at our institution. METHODS One hundred fifteen MCA aneurysms in 115 patients (mean age, 55.1 years) were treated by an endovascular technique from April 1990 to March 2007. Forty-eight patients (42%) presented with acute subarachnoid hemorrhage, and 67 patients (58%) had unruptured aneurysms. Fifty-three aneurysms (46%) were small with a small neck, 28 (24%) were small with a wide neck, 22 (19%) were large, and 12 (11%) were giant. RESULTS Angiographic results immediately after embolization showed complete occlusion in 53 aneurysms (46%), a neck remnant in 51 (44%), and incomplete occlusion in 3 (3%). Because of anatomic difficulties, we could not embolize 8 aneurysms (7%). Thirteen patients underwent combined treatment that included endovascular and extracranial-intracranial bypass surgery. Morbidity and mortality rates were 6.9% (8 patients) and 3% (3 patients), respectively. Procedure-related complications were encountered in 10 patients (9%). Seventy patients had long-term follow-up angiograms. Seven aneurysms (10%) were recanalized; all were large or giant. One partially embolized large aneurysm ruptured 13 months after embolization. CONCLUSION In this series, endovascular coil embolization of MCA aneurysms has morbidity and mortality rates comparable to those of conventional surgical clipping. Combined treatment of endovascular and bypass surgery can successfully treat large or giant complex fusiform MCA aneurysms.

Impact of the global outflow angle on recanalization after endovascular treatment of middle cerebral artery bifurcation aneurysms

2018 ◽  
Vol 10 (12) ◽  
pp. 1174-1178 ◽  
Author(s):  
Yannick de La Torre ◽  
Stéphane Velasco ◽  
Jean-Pierre Tasu ◽  
Cassandre Wanpouille ◽  
Paul Chan ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Predictive Factors ◽  
Univariate Analysis ◽  
Three Dimensional ◽  
Flow Angle ◽  
Neck Size ◽  
Spatial Coordinates ◽  
Independent Risk Factors

Background and purposeIntracranial aneurysm recanalization after endovascular treatment (EVT) remains a major problem. The goal of this study was to find new predictive factors of recanalization after EVT of middle cerebral artery (MCA) bifurcation aneurysms.Methods96 MCA bifurcationaneurysms, ruptured or unruptured, treated by EVT between Septembre 2009 and December 2014, were retrospectively included. Clinical parameters and aneurysm characteristics were recorded. From the initial three-dimensional DSA, spatial coordinates found on parent and daughter arteries of MCA bifurcations gave four different flow angle values; inflow, outflows 1 and 2, and the global outflow angle (the sum of the two outflow angles). Inter- and intra-observer reproducibilities of three-dimensional angle value measurements were performed.ResultsRecanalization occurred in 25 cases (26%) and retreatment was performed in 11 cases (11%). Only 1 patient (1%) had rebleeding. Univariate analysis established the following as predictive factors of recanalization: high blood pressure (P=0.014), aneurysm height (P<0.001), aneurysm width (P<0.001), neck size (P<0.001), postoperative occlusion class (P=0.040), percentage of packing volume (P<0.001), as well as the two outflow angles (P=0.006 and 0.045), and the global outflow angle (P<0.001). Multivariate analysis revealed two independent risk factors for recanalization: the global outflow angle (OR=1.05; 95% CI 1.02 to 1.08; P<0.002) and aneurysm width (OR=0.67; 95% CI 0.46 to 0.96; P=0.031). A global outflow angle threshold <192° was found to be a risk factor for recanalization (OR=13.75; 95% CI 4.46 to 42.44), with a sensitivity of 80% and specificity of 77%.ConclusionsThis study emphasizes that a new parameter, the global outflow angle, can be predictive of recanalization for MCA bifurcation aneurysms treated by EVT.

Endovascular Treatment of Middle Cerebral Artery Dissecting Aneurysms: A 7-Year Single-Center Study

2018 ◽  
Vol 112 ◽  
pp. e119-e124
Author(s):  
Puyuan Zhao ◽  
Deyuan Zhu ◽  
Wanling Wen ◽  
Yu Zhou ◽  
Yibin Fang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Single Center ◽  
Single Center Study ◽  
Dissecting Aneurysms ◽  
Center Study

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.

scholarly journals Intracranial Mechanical Recanalization and Fibrinolysis Using a Single Hyperglide Balloon Microcatheter

2005 ◽  
Vol 11 (3) ◽  
pp. 277-280
Author(s):  
E. Castro Reyes ◽  
F. Fortea Gil ◽  
F. Villoria Medina ◽  
J. Guzmán De Villoria ◽  
L. Muñoz Almazán ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Procedure Time ◽  
Mechanical Recanalization

Endovascular treatment of acute blockage of the middle cerebral artery may require a combination of mechanical recanalization and chemical fibrinolysis. Using a single microcatheter to perform both techniques helps shorten procedure time.

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%.

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