title: Various techniques of stent-assisted coil embolization of wide-necked or fusiform middle cerebral artery aneurysms : initial and mid-term results.
abstract: OBJECTIVE
  To evaluate the feasibility and clinical and angiographic outcomes of stent-assisted embolization for complex middle cerebral artery (MCA) aneurysms.
  
  
  METHODS
  The records of 23 consecutive patients with 24 MCA aneurysms, who underwent stent-assisted embolization of the aneurysm, were retrospectively evaluated.
  
  
  RESULTS
  Fifteen aneurysms were treated with one stent and 8 were treated using more than two stents (5 a stent-within-a-stent, 1 triple stents, and two Y-stent). Angiographically, complete or near complete occlusion was achieved in 15 aneurysms (65.2%), residual neck in five (21.7%), and residual aneurysm in three (13.1%). Five aneurysms demonstrated thrombosis within the stent during the procedure and hospitalization, and were resolved by intraarterial and intravenous Tirofiban injection. Symptomatic thromboembolic complications were developed in five patients and permanent deficits demonstrated in two patients with modified Rankin Scale 1 and 2, respectively. Treatment-related permanent morbidity and mortality rates were 8.3% and 0% with relatively high complication rate. Angiographic follow-up was available in 17 aneurysms at 6-31 months (mean, 13.2 months) and showed stable or improved in 15 (88.2%) and major and minor recurrence in one, respectively.
  
  
  CONCLUSIONS
  Complex MCA aneurysms could be treated by stent-assisted coiling and showed lower recanalization rate during mid-term follow-up by effective flow diversion due to various stent-assisted techniques. Our results warrant further study with a longer follow-up period in a larger sample.
authors.affiliation: Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Yu Sam
authors.initials: YS
authors.lastname: Won
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Rho
authors.forename: Byung Moon
authors.initials: BM
authors.lastname: Kim
authors.forename: Hee Jin
authors.initials: HJ
authors.lastname: Park
authors.forename: Hyon Ju
authors.initials: HJ
authors.lastname: Kwag
authors.forename: Eun Chul
authors.initials: EC
authors.lastname: Chung
keywords: Coil embolization; Intracranial aneurysm; Middle cerebral artery; Stent
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