Endovascular treatment for saccular aneurysms of the proximal (M1) segment of the middle cerebral artery.
BACKGROUND
Saccular aneurysms located at the M1 segment of the middle cerebral artery (MCA) are uncommon, and endovascular treatment (EVT) for them is not well documented. We performed this study to evaluate the feasibility, safety, and efficacy of EVT for proximal (M1) segment saccular aneurysm of the middle cerebral artery.


METHODS
Of 153 MCA aneurysms between January 2007 and September 2011, 29 patients with 29 M1 segment saccular aneurysms were treated at our institution via endovascular approach. There were 14 men and 15 women with a mean age of 56.2 years (range 36-78 years).


RESULTS
Treatments were successful in 28 (96.6 %) cases, including coiling alone in 19 patients, stent-assisted coiling in 8, and balloon-assisted coiling in 1. In the failed case, coiling was not successful, and only a stent was deployed. Immediate angiograms showed total occlusion in 13 patients, neck remnant in 7, partial occlusion in 8, and contrast stasis in the patient who was not coiled successfully. Two (6.9 %) procedure-related complications occurred, including early temporal branch (ETB) obliteration in one patient and lenticulostriate artery (LSA) occlusion in the other one, which resulted in hemiparalysis of one patient. Three patients died from initial severe SAH during hospitalization. One patient died from heart infarction 1 month after operation. Twenty-three of 25 surviving patients underwent follow-up cerebral angiography at intervals ranging from 1 to 21 months (mean, 7.3 months). The result showed 14/23 (60.9 %) aneurysms were completely occluded, 3/23 (13 %) were recanalized, and others were stable or improved. The clinical follow-up (mean, 22.5 months) of all survived patients demonstrated no neurologic deterioration or rebleeding.


CONCLUSIONS
Our preliminary experience demonstrates that EVT for proximal MCA aneurysm is feasible and safe. However, more adequate follow-up is required to evaluate its long-term results.
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, Peoples Republic of China.
Yu
Y
Zhou
Peng-Fei
PF
Yang
Yi-Bin
YB
Fang
Yi
Y
Xu
Bo
B
Hong
Wen-Yuan
WY
Zhao
Qiang
Q
Li
Rui
R
Zhao
Qing-Hai
QH
Huang
Jian-Min
JM
Liu
D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome