title: Flow Diversion in Middle Cerebral Artery Aneurysms: Is It Really an All-Purpose Treatment?
abstract: OBJECTIVE
  The outcome of flow diversion for middle cerebral artery (MCA) aneurysms, one of the most common sites for intracranial aneurysms, has not been defined thoroughly. We assessed our outcomes in MCA aneurysms (MCAAs) treated by flow diversion, i.e., with either dedicated flow diverters or telescopic stents.
  
  
  METHODS
  Patients with MCAAs were treated by flow diversion if surgical or other endovascular treatment modalities had failed or were deemed likely to fail. Angiographic and clinical outcome of these patients was assessed retrospectively. Aneurysm location on MCA was defined as M1 segment, "true bifurcation" (classical bifurcation of MCA into superior and inferior trunks), "variant bifurcation" (bifurcation of early frontal or early/distal temporal branches), or M2 segment. Aneurysm morphology was classified as saccular versus dissecting/fusiform.
  
  
  RESULTS
  Treatment was attempted in 29 MCAAs. Technical failure rate was 3.4% (1/29). Thirteen of aneurysms were fusiform. Of the bifurcation aneurysms, most (10/16) were the variant type. Overall and procedure-related mortality/permanent morbidity rates were 10.3% (3/29) and 3.5% (1/29). Total occlusion rates (mean angiographic follow-up 10.3 months) for saccular and fusiform aneurysms were 40% and 75%, respectively. In bifurcation aneurysms, occlusion was strongly associated with side-branch occlusion (P < 0.005).
  
  
  CONCLUSIONS
  In this series, flow diversion for the treatment of MCAAs was safe, was effective in the treatment of fusiform MCAAs, and was not as effective at mid-term for MCA bifurcation aneurysms. Unsatisfactory occlusion rate in bifurcation aneurysms likely results from residual filling of the aneurysms in cases in which the jailed side branch remains patent.
authors.affiliation: Department of Radiology, Kecioren Education and Research Hospital, Ankara, Turkey.
authors.forename: Osman Melih
authors.initials: OM
authors.lastname: Topcuoglu
authors.affiliation: Department of Radiology, Cukurova University Medical School, Adana, Turkey.
authors.forename: Erol
authors.initials: E
authors.lastname: Akgul
authors.affiliation: Department of Neurosurgery, Numune Education and Research Hospital, Ankara, Turkey.
authors.forename: Ergun
authors.initials: E
authors.lastname: Daglioglu
authors.affiliation: Department of Radiology, Ufuk University Medical School, Ankara, Turkey.
authors.forename: Elif Dilara
authors.initials: ED
authors.lastname: Topcuoglu
authors.affiliation: Department of Radiology, Hacettepe University Medical School, Ankara, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Peker
authors.affiliation: Department of Radiology, Numune Education and Research Hospital, Ankara, Turkey.
authors.forename: Ilkay
authors.initials: I
authors.lastname: Akmangit
authors.affiliation: Department of Neurosurgery, Numune Education and Research Hospital, Ankara, Turkey.
authors.forename: Deniz
authors.initials: D
authors.lastname: Belen
authors.affiliation: Department of Radiology, Numune Education and Research Hospital, Ankara, Turkey; Department of Radiology, Hacettepe University Medical School, Ankara, Turkey. Electronic address: anilarat@hotmail.com.
authors.forename: Anil
authors.initials: A
authors.lastname: Arat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000009:adverse effects / Q000379:methods*; D002675:Child, Preschool; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000401:mortality / Q000601:surgery*; D020767:Intracranial Thrombosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: Aneurysm; Endovascular treatment; Flow diversion; Flow diverter; Middle cerebral artery