Results of endovascular treatment of middle cerebral artery aneurysms after first giving consideration to clipping.
BACKGROUND
Middle cerebral artery (MCA) aneurysms are among the more challenging aneurysms for endovascular treatment. We report a contemporary 5-year experience with endovascular therapy for MCA aneurysms at a high-volume neurovascular center.


METHODS
Review of prospectively maintained intracranial aneurysm database.


RESULTS
Between 2005 and 2009, 148 patients underwent treatment of 149 MCA aneurysms at our hospital, of which 33 patients with 34 aneurysms underwent endovascular therapy. Among these 33 patients, 14 presented with subarachnoid hemorrhage. Eleven patients were treated with stent-assisted coiling, 1 with balloon-assisted coiling, and the remainder with coiling alone. Three patients required repeat endovascular treatment. There were 7 periprocedural complications, including intraprocedural aneurysm rupture resulting in death in 2 patients. Two patients died at later dates from remote aneurysm rehemorrhage. Average follow-up of remaining patients was 17.1 months radiographically, and 20.3 months clinically. Average modified Rankin scale (mRS) score at last follow up was 2.09, with 17 patients with mRS 0/1 and 5 patients with mRS 2. Fifteen patients showed evidence of radiographic residual at last follow up: 13 were simple neck residuals. Unruptured status and saccular aneurysms were associated with mRS 0/1 outcome (each p < 0.05).


CONCLUSIONS
At our hospital, MCA aneurysms are being treated with endovascular techniques, but in a minority of patients. Despite the rate of residual neck remnants, few retreatments were necessary and few rehemorrhages occurred. The periprocedural complication rate was not insignificant; therefore, in more recent years and at present, most MCA aneurysms are considered for clipping first at our center.
Department of Neurosurgery and Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, NY, USA.
Adib A
AA
Abla
Shady
S
Jahshan
Peter
P
Kan
Maxim
M
Mokin
Travis M
TM
Dumont
Jorge L
JL
Eller
Kenneth V
KV
Snyder
L Nelson
LN
Hopkins
Adnan H
AH
Siddiqui
Elad I
EI
Levy
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D013345:Subarachnoid Hemorrhage / Q000601:surgery*; D013525:Surgical Instruments; D016896:Treatment Outcome