Endovascular treatment of middle cerebral artery aneurysms for 120 nonselected patients: a prospective cohort study

Abstract

Background and purpose: Multiple technologies have developed the endovascular approach to MCA aneurysms. We assess the safety and the efficacy of a systematic endovascular approach in nonselected patients with MCA aneurysms and determine predictors of treatment outcomes.

Materials and methods: We analyzed data collected between January 2007 and January 2012 in a prospective clinical registry. All patients with MCA aneurysms treated by means of the endovascular approach were included. A multivariate analysis was conducted to identify predictors of complications, recanalization, and outcome.

Results: A total of 120 patients with 131 MCA aneurysms were included. Seventy-nine patients (65.8%) were treated electively and 41 (34.2%) in the setting of subarachnoid hemorrhage. Thirty-three of 131 aneurysms (25.2%) were treated with simple coiling, 79 aneurysms (60.3%) with balloon-assisted coiling, and 19 aneurysms (14.5%) with stent-assisted coiling. Complications occurred in 13.7% of patients. Stent-assisted coiling was significantly associated with more complications (P = .002; OR: 4.86; 95% CI, 1.60-14.72). At 1 month after treatment, both the permanent morbidity (mRS ≤2) and mortality rates were 3.3%, without any significant difference according to the endovascular techniques. Mean angiographic follow-up was 16.3 months. The rate of recanalization was 15.6% without a statistical difference, according to the technique. Larger aneurysms were a predictor of recanalization (P = .016; OR: 1.183; 95% CI, 1.02-1.36). Retreatment was performed in 10 of 131 aneurysms (7.6%).

Conclusions: Even though stent-assisted coiling significantly increases the risk of procedural complications, endovascular treatment of MCA aneurysms is safe, effective, and provides durable aneurysm closure in nonselected patients.

Fig 1.

A 68-year-old man with unruptured right MCA bifurcation aneurysm. A, 3D reconstruction after rotational angiogram of right internal carotid artery shows an 8-mm aneurysm (asterisk) with a 7-mm-wide neck, which can be considered unsuitable for EVT. The superior trunk (arrow) is incorporated into the aneurysm neck. B, Angiogram of right internal carotid artery shows coiling with double-catheter technique (arrow). C, Angiogram of right internal carotid artery directly after coiling demonstrates persistent opacification of the aneurysm neck. D, Angiogram of right internal carotid artery performed 16 months after coiling, showing complete aneurysm occlusion.

Fig 2.

A 54-year-old woman with unruptured left MCA bifurcation aneurysm. A, 3D reconstruction after rotational angiogram of left internal carotid artery shows a 7-mm aneurysm with a 4-mm-wide neck in the MCA bifurcation. Both MCA branches (arrows) are incorporated into the aneurysm neck. B, Angiogram of left internal carotid artery obtained during EVT with coils. The aneurysm is treated by means of the balloon-assisted technique by use of a round balloon (asterisk) to avoid coil protrusion (arrow). C, Angiogram of left internal carotid artery at the end of the procedure. There is persistent opacification of the aneurysm neck. D, Angiogram of left internal carotid artery at 23-month follow-up shows complete occlusion of the aneurysm and patent parent artery.