Endovascular treatment of middle cerebral artery aneurysms as first option: a single center experience of 92 aneurysms

Abstract

Background and purpose: We conducted a retrospective evaluation of the results of endovascular treatment (EVT) of middle cerebral artery aneurysms (MCAAs) in a center where embolization is the first treatment option considered.

Materials and methods: Ninety-two MCAAs were diagnosed in 87 patients between September 2001 and January 2006. The strategy of treatment (endovascular versus surgical), the clinical and angiographic results of embolization, and the ensuing complications are described.

Results: Initially, 59 aneurysms (64.1%) in 55 patients were embolized, 18 (19.6%) were clipped, and 15 (16.3%) were not treated. Four endovascular procedures failed (7.3%), and 55 aneurysms in 51 patients were finally treated by embolization. During the procedure, complications occurred in 13 patients (25.5%) comprising 3 ruptures and 10 thromboembolisms. In the follow-up, 4 patients having a preoperative complication had a modified Rankin scale more than 2 (3 patients [5.9%]) or died (1 patient [2.0%]). Of the 55 embolized aneurysms, according to the Raymond scale, 23 (41.8%) were completely occluded, 24 (43.6%) retained a residual neck, and 8 (14.6%) were residual at the end of the first procedure. No bleeding was detected during the follow-up period in the embolized patients.

Conclusion: EVT of MCAA is effective for preventing rebleeding episodes within the first year of treatment judging by historical controls. The real question is whether clipping or coiling of MCAAs is better in terms of reducing rebleeding rates and complications rates in the long term, and such a determination would require a far larger number of patients over a much longer observation period.

Fig 1.

Raymond classification for aneurysmal occlusions. (Reproduced with permission from Roy D, Milot G, Raymond J. Endovascular treatment of unruptured aneurysms. Stroke 2001;32:1998–2004.)

Fig 2.

Flow chart of options for treatment of MCAAs.

Fig 3.

Distribution of 59 MCAAs initially proposed for EVT. ACA indicates anterior cerebral artery.

Fig 4.

Diameter of 59 MCAAs initially proposed for EVT.

Fig 5.

Flow chart of occlusion rates for 55 aneurysms treated by endovascular coiling. * indicates patients who died or were lost to follow-up; §, surgically treated patients.