title: Endovascular treatment of middle cerebral artery aneurysms as first option: a single center experience of 92 aneurysms.
abstract: OBJECTIVE
  We conducted a retrospective evaluation of the results of endovascular treatment (EVT) of middle cerebral artery aneurysms (MCAAs) in a center where embolization is the first treatment option considered.
  
  
  METHODS
  Ninety-two MCAAs were diagnosed in 87 patients between September 2001 and January 2006. The strategy of treatment (endovascular versus surgical), the clinical and angiographic results of embolization, and the ensuing complications are described.
  
  
  RESULTS
  Initially, 59 aneurysms (64.1%) in 55 patients were embolized, 18 (19.6%) were clipped, and 15 (16.3%) were not treated. Four endovascular procedures failed (7.3%), and 55 aneurysms in 51 patients were finally treated by embolization. During the procedure, complications occurred in 13 patients (25.5%) comprising 3 ruptures and 10 thromboembolisms. In the follow-up, 4 patients having a preoperative complication had a modified Rankin scale more than 2 (3 patients [5.9%]) or died (1 patient [2.0%]). Of the 55 embolized aneurysms, according to the Raymond scale, 23 (41.8%) were completely occluded, 24 (43.6%) retained a residual neck, and 8 (14.6%) were residual at the end of the first procedure. No bleeding was detected during the follow-up period in the embolized patients.
  
  
  CONCLUSIONS
  EVT of MCAA is effective for preventing rebleeding episodes within the first year of treatment judging by historical controls. The real question is whether clipping or coiling of MCAAs is better in terms of reducing rebleeding rates and complications rates in the long term, and such a determination would require a far larger number of patients over a much longer observation period.
authors.affiliation: Department of Neuroradiology, University Hospital of Reims, Reims, France.
authors.forename: R S
authors.initials: RS
authors.lastname: Quadros
authors.forename: S
authors.initials: S
authors.lastname: Gallas
authors.forename: R
authors.initials: R
authors.lastname: Noudel
authors.forename: P
authors.initials: P
authors.lastname: Rousseaux
authors.forename: L
authors.initials: L
authors.lastname: Pierot
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000209:etiology; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D012189:Retrospective Studies; D013923:Thromboembolism / Q000209:etiology; D017211:Treatment Failure; D016896:Treatment Outcome