title: Middle Cerebral Artery Bifurcation Aneurysms Treated by Extrasaccular Flow Diverters: Midterm Angiographic Evolution and Clinical Outcome.
abstract: Flow diverters have been increasingly used lately in off-label, distal intracranial aneurysm treatments. Our aim was to evaluate the effectiveness of flow diverters in the treatment of middle cerebral artery bifurcation aneurysms and to analyze midterm angiographic patterns of regional flow modifications for safety and clinical outcomes.
  
  
  
  Consecutive patients treated from January 2010 to December 2014 by the authors by using endovascular flow-diverting stents for MCA bifurcation aneurysms were evaluated retrospectively with prospectively maintained data. All patients had been followed for at least 12 months after treatment, with at least 2 control angiograms; regional flow-related angiographic modifications were registered by using a new angiographic outcome scale for flow diverters. Data were analyzed with emphasis on procedure-related events, angiographic results, and clinical outcome.
  
  
  
  Fifty-eight patients were included in the study, with 63 MCA bifurcation aneurysms; 13 of these were large and giant. Pretreatment mRS was 0 for 12 patients (20.7%), 1 for 41 (70.7%), and 2 for 5 patients (8.6%). Six-month control revealed mRS 0-2 for 57 (98.3%) patients and 3 for 1 (1.7%) patient. Procedure-related morbidity and mortality were 8.6% (5/58) and 0%, respectively. From 95% of still circulating immediate postprocedure angiographic outcomes, 68% progressed to aneurysm occlusion at 6 months and 95%, to occlusion at 12 months, with a 0% aneurysm rupture rate.
  
  
  
  Flow diverters seem to be an effective treatment alternative for complex MCA bifurcation aneurysms, with reasonable complication rates. Longer angiographic follow-ups are needed to assess the morphologic outcome; immediate subtotal occlusions do not seem to be related to rupture.
authors.affiliation: From the Interventional Neuroradiology Department (C.I., C.M., S.S.), Dupuytren University Hospital (Centre Hospitalier Universitaire Limoges), Limoges, France christina.iosif@gmail.com christinaiosif@yahoo.gr.
authors.forename: C
authors.identifier: 0000-0003-1001-2331
authors.initials: C
authors.lastname: Iosif
authors.affiliation: From the Interventional Neuroradiology Department (C.I., C.M., S.S.), Dupuytren University Hospital (Centre Hospitalier Universitaire Limoges), Limoges, France.
authors.forename: C
authors.identifier: 0000-0002-5894-9599
authors.initials: C
authors.lastname: Mounayer
authors.affiliation: Interventional Neuroradiology Department (K.Y.), Ankara University, School of Medicine, Ankara, Turkey.
authors.forename: K
authors.identifier: 0000-0002-3496-4460
authors.initials: K
authors.lastname: Yavuz
authors.affiliation: From the Interventional Neuroradiology Department (C.I., C.M., S.S.), Dupuytren University Hospital (Centre Hospitalier Universitaire Limoges), Limoges, France.
authors.forename: S
authors.identifier: 0000-0002-8602-4155
authors.initials: S
authors.lastname: Saleme
authors.affiliation: Interventional Neuroradiology Department (S.G.), Memorial HealthCare Group, Istanbul, Turkey.
authors.forename: S
authors.identifier: 0000-0003-0767-5628
authors.initials: S
authors.lastname: Geyik
authors.affiliation: Interventional Neuroradiology Department (H.S.C.), Koru Hospital and Bayındır Hospital, Ankara, Turkey.
authors.forename: H S
authors.identifier: 0000-0002-4521-2301
authors.initials: HS
authors.lastname: Cekirge
authors.affiliation: Interventional Neuroradiology Department (I.S.), Yuksek Ihtisas University, Koru Hospital, Ankara, Turkey.
authors.forename: I
authors.identifier: 0000-0003-1690-5501
authors.initials: I
authors.lastname: Saatci
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography / Q000379:methods*; D057510:Endovascular Procedures / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome