title: Simple coiling using single or multiple catheters without balloons or stents in middle cerebral artery bifurcation aneurysms.
abstract: BACKGROUND
  We evaluated the outcomes of middle cerebral artery bifurcation (MCAB) aneurysms treated with simple coiling using single or multiple catheters without stents or balloons.
  
  
  METHODS
  This study included 100 patients with 103 MCAB aneurysms who underwent a simple coiling procedure without the adjuvant use of stents or balloons. The angiographic clinical outcomes and recurrence of these aneurysms were evaluated.
  
  
  RESULTS
  Of the 103 aneurysms, 102 (99.0 %) aneurysms were successfully treated with simple coiling. One patient died from the consequences of a procedural aneurysm rupture. The treatment-associated permanent morbidity and mortality rates were 0 and 1.0 %, respectively. Post-coiling angiograms showed 28 complete occlusions (27.2 %), 60 neck remnants (58.3 %), and 14 partial occlusions (13.6 %). A follow-up angiography (median duration, 30 months; range, 3-73 months) was performed in 80 lesions. Recanalisation was found in 28 lesions (35.0 %), of which 6 were complete occlusions, 18 were neck remnants, and 4 were partial occlusions, as determined by post-coiling angiograms. Among these lesions, 14 major recurrences were retreated with coiling (n = 12) and clipping (n = 2) without complications. Age (odds ratio [OR], 0.93; 95 % confidence interval [CI], -0.11 to -0.01; p = 0.03), the presence of a rupture (OR, 3.89; 95 % CI, 0.12 to 2.60; p = 0.03), and a wide aneurysm neck (OR, 6.40; 95 % CI, 0.57 to 3.14; p = 0.005) were significantly associated with the aneurysm recurrence, as determined by multivariable analyses.
  
  
  CONCLUSIONS
  Our study suggests that simple coiling of MCAB aneurysms is feasible and safe; however, it has limitations in durability, particularly in ruptured or wide-necked aneurysms and in young patients.
authors.affiliation: Department of Neurosurgery, Inje University, Haeundae Paik Hospital, Busan, South Korea.
authors.forename: Sung-Chul
authors.initials: SC
authors.lastname: Jin
authors.forename: O-Ki
authors.initials: OK
authors.lastname: Kwon
authors.forename: Chang Wan
authors.initials: CW
authors.lastname: Oh
authors.forename: Jae Seung
authors.initials: JS
authors.lastname: Bang
authors.forename: Gyojun
authors.initials: G
authors.lastname: Hwang
authors.forename: Nam Mi
authors.initials: NM
authors.lastname: Park
authors.forename: Eun A
authors.initials: EA
authors.lastname: Jung
authors.forename: Moon Hee
authors.initials: MH
authors.lastname: Han
authors.forename: Hyun-Seung
authors.initials: HS
authors.lastname: Kang
authors.forename: Hyun
authors.initials: H
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D002406:Catheterization, Peripheral / Q000401:mortality*; D004621:Embolization, Therapeutic / Q000379:methods* / Q000401:mortality*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D015607:Stents; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome