title: Endovascular coiling of middle cerebral artery aneurysms as an alternative to surgical clipping.
abstract: Surgical clipping is preferred to endovascular coil embolization for the treatment of middle cerebral artery (MCA) aneurysms. The aim of this study was to describe our experience of coiling for MCA aneurysms, to analyze the reasons for choosing coiling instead of clipping, and to evaluate the appropriateness of the choice. We retrospectively reviewed data of 30 patients who had coiling for MCA aneurysms in our Institute from January 2008 to February 2011. We analyzed the morphologies, techniques, angiographic results and complications of 30 aneurysms treated with coiling, and compared the outcomes with those of 78 clipped aneurysms during the same period. The most common reason for choosing coiling instead of clipping was the short length of the M1 artery (17/30, 56.7%). Complete obliteration of the aneurysm was achieved in 28 of 30 coiling patients (93%) and in 72 of 78 clipping patients (92%). In the coiling group, two of 30 patients (6.7%) had post-procedural infarctions on radiologic evaluation, with only one infarction in clinically relevant territory. There was one intra-procedural rupture and one aneurysm recanalization requiring retreatment in the coiling group. In the clipping group, two infarctions, one subdural hygroma and two intracerebral hematomas were found as postoperative complications, with two clinical deteriorations. Endovascular coil embolization should be considered for treatment of MCA aneurysms as it has angiographic results equivalent to surgical clipping and acceptable post-procedural complications. It is particularly appropriate for patients with serious medical problems or where there is the risk of damaging perforating lenticulostriate arteries on the MCA during surgery.
authors: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea.
authors: Kyung-Hwan
authors: KH
authors: Kim
authors: Ki-Chul
authors: KC
authors: Cha
authors: Jong-Soo
authors: JS
authors: Kim
authors: Seung-Chyul
authors: SC
authors: Hong
mesh_terms: D000800:Angioplasty, Balloon / Q000295:instrumentation; D057785:Catheters; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000601:surgery; D038524:Diffusion Magnetic Resonance Imaging; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery*; D015607:Stents