Endovascular coil occlusion of 152 middle cerebral artery aneurysms: initial and midterm angiographic and clinical results.
OBJECTIVE
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.
Department of Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire Nancy, Nancy, France. s.bracard@gmail.com
Serge
S
Bracard
Amr
A
Abdel-Kerim
Lorrena
L
Thuillier
Olivier
O
Klein
René
R
Anxionnat
Stefanos
S
Finitsis
Ariel
A
Lebedinsky
Clayton Maceido
CM
de Freitas
Nilson
N
Pinheiro
Guillerme Cabral
GC
de Andrade
Luc
L
Picard
D017542:Aneurysm, Ruptured / Q000401:mortality; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000401:mortality; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D008297:Male; D009017:Morbidity; D018458:Persistent Vegetative State / Q000401:mortality; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome