INTERVENTIONAL RADIOLOGY / ORIGINAL PAPER
Endovascular treatment of middle cerebral artery aneurysms – single-centre results
1
Chair of Radiology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
2
Students’ Scientific Group, Chair of Radiology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
3
Department of Radiology, University Hospital in Krakow, Poland
4
Department of Neurosurgery and Neurotraumatology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
Submission date: 2020-04-13
Final revision date: 2020-06-25
Acceptance date: 2020-06-26
Publication date: 2020-12-20
Pol J Radiol, 2020; 85: 650-656
KEYWORDS
TOPICS
ABSTRACT
Introduction:
The middle cerebral artery (MCA) is the second most common location of intracerebral aneurysms. Traditionally, they are treated by microsurgical clipping, but with the development of new techniques and devices endovascular embolisation is gaining more importance. The aim of this study was to summarise six years of experience of our department in endovascular treatment of MCA aneurysms.
Material and methods:
Forty patients with 41 MCA aneurysms treated in a single centre were included in this study. Data on patients’ comorbidities, aneurysm morphology, and treatment course were collected, with special emphasis on complications.
Results:
There were no statistically significant differences in terms of aneurysm morphology between males and females and between ruptured and unruptured aneurysms. None of the diseases analysed in the current study were linked with significantly increased risk of SAH. Unruptured aneurysms were significantly more frequently treated by stent-assisted coiling (30.4% vs. 5.6%, p = 0.0388) than were ruptured aneurysms, while ruptured aneurysms were treated more frequently by coiling alone (77.8% vs. 34.8%, p = 0.0062). After an initial course of treatment 63.4% (n = 26) of patients had class I in Raymond-Roy occlusion classification, 22% (n = 9) had class II, and 14.6% (n = 6) had class III. Complications of the procedure were observed in 17.5% (n = 7) of patients: 22.2% (n = 4) with ruptured and 13.6% (n = 3) with unruptured aneurysms.
Conclusions:
Endovascular treatment of MCA aneurysms is feasible, and our results are convergent with other studies. Ruptured MCA aneurysms may be treated endovascularly with similar effects as unruptured MCA aneurysms. The complication rate of such treatment is low.
The middle cerebral artery (MCA) is the second most common location of intracerebral aneurysms. Traditionally, they are treated by microsurgical clipping, but with the development of new techniques and devices endovascular embolisation is gaining more importance. The aim of this study was to summarise six years of experience of our department in endovascular treatment of MCA aneurysms.
Material and methods:
Forty patients with 41 MCA aneurysms treated in a single centre were included in this study. Data on patients’ comorbidities, aneurysm morphology, and treatment course were collected, with special emphasis on complications.
Results:
There were no statistically significant differences in terms of aneurysm morphology between males and females and between ruptured and unruptured aneurysms. None of the diseases analysed in the current study were linked with significantly increased risk of SAH. Unruptured aneurysms were significantly more frequently treated by stent-assisted coiling (30.4% vs. 5.6%, p = 0.0388) than were ruptured aneurysms, while ruptured aneurysms were treated more frequently by coiling alone (77.8% vs. 34.8%, p = 0.0062). After an initial course of treatment 63.4% (n = 26) of patients had class I in Raymond-Roy occlusion classification, 22% (n = 9) had class II, and 14.6% (n = 6) had class III. Complications of the procedure were observed in 17.5% (n = 7) of patients: 22.2% (n = 4) with ruptured and 13.6% (n = 3) with unruptured aneurysms.
Conclusions:
Endovascular treatment of MCA aneurysms is feasible, and our results are convergent with other studies. Ruptured MCA aneurysms may be treated endovascularly with similar effects as unruptured MCA aneurysms. The complication rate of such treatment is low.
REFERENCES (27)
1.
Huttunen T, von und zu Fraunberg M, Frösen J, et al. Saccular intracranial aneurysm disease. Neurosurgery 2010; 66: 631-638.
2.
Rinne J, Hernesniemi J, Niskanen M, Vapalahti M. Analysis of 561 patients with 690 middle cerebral artery aneurysms: anatomic and clinical features as correlated to management outcome. Neurosurgery 1996; 38: 2-11.
3.
Deruty R, Pelissou-Guyotat I, Mottolese C, Amat D. Management of unruptured cerebral aneurysms. Neurol Res 1996; 18: 39-44.
4.
Regli L, Uske A, de Tribolet N. Endovascular coil placement compared with surgical clipping for the treatment of unruptured middle cerebral artery aneurysms: a consecutive series. J Neurosurg 1999; 90: 1025-1030.
5.
Rodríguez-Hernández A, Sughrue ME, Akhavan S, et al. Current management of middle cerebral artery aneurysms: surgical results with a “clip first” policy. Neurosurgery 2013; 72: 415-427.
6.
Smith TR, Cote DJ, Dasenbrock HH, et al. Comparison of the efficacy and safety of endovascular coiling versus microsurgical clipping for unruptured middle cerebral artery aneurysms: a systematic review and meta-analysis. World Neurosurg 2015; 84: 942-953.
7.
Eboli P, Ryan RW, Alexander JE, Alexander MJ. Evolving role of endovascular treatment for MCA bifurcation aneurysms: case series of 184 aneurysms and review of the literature. Neurol Res 2014; 36: 332-338.
8.
Horowitz M, Gupta R, Gologorsky Y, et al. Clinical and anatomic outcomes after endovascular coiling of middle cerebral artery aneurysms: report on 30 treated aneurysms and review of the literature. Surg Neurol 2006; 66: 167-171; discussion 171.
9.
Brinjikji W, Rabinstein AA, Nasr DM, et al. Better outcomes with treatment by coiling relative to clipping of unruptured intracranial aneurysms in the United States, 2001-2008. Am J Neuroradiol 2011; 32: 1071-1075.
10.
Qureshi AI, Vazquez G, Tariq N, et al. Impact of International Subarachnoid Aneurysm Trial results on treatment of ruptured intracranial aneurysms in the United States. J Neurosurg 2011; 114: 834-841.
11.
de Rooij NK, Linn FHH, van der Plas JA, et al. Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry 2007; 78: 1365-1372.
12.
Weir B, Disney L, Karrison T. Sizes of ruptured and unruptured aneurysms in relation to their sites and the ages of patients. J Neurosurg 2002; 96: 64-70.
13.
Brzegowy P, Polak J, Wnuk J, et al. Middle cerebral artery anatomical variations and aneurysms – retrospective study based on computed tomography angiography findings. Folia Morphol (Warsz) 2018; 77: 434-440.
14.
Aguilar-Perez M, Kurre W, Fischer S, et al. Coil occlusion of wide-neck bifurcation aneurysms assisted by a novel intra- to extra-aneurysmatic neck-bridging device (pCONus): initial experience. Am J Neuroradiol 2014; 35: 965-971.
15.
Mukherjee S, Chandran A, Gopinathan A, et al. PulseRider-assisted treatment of wide-necked intracranial bifurcation aneurysms: safety and feasibility study. J Neurosurg 2017; 127: 61-68.
16.
Lv X, Zhang Y, Jiang W. Systematic review of woven endobridge for wide-necked bifurcation aneurysms: complications, adequate occlusion rate, morbidity, and mortality. World Neurosurg 2018; 110: 20-25.
17.
Link TW, Boddu SR, Hammad HT, et al. Endovascular treatment of middle cerebral artery aneurysms: a single center experience with a focus on thromboembolic complications. Interv Neuroradiol 2018; 24: 14-21.
18.
McDougall CG, Spetzler RF, Zabramski JM, et al. The barrow ruptured aneurysm trial. J Neurosurg 2012; 116: 135-144.
19.
Dhar S, Tremmel M, Mocco J, et al. Morphology parameters for intracranial aneurysm rupture risk assessment. Neurosurgery 2008; 63: 185-197.
20.
Grochowski C, Litak J, Kulesza B, et al. Size and location correlations with higher rupture risk of intracranial aneurysms. J Clin Neurosci 2018; 48: 181-184.
21.
Kadkhodayan Y, Delgado Almandoz JE, Fease JL, et al. Endovascular treatment of 346 middle cerebral artery aneurysms. Neurosurgery 2015; 76: 54-61.
22.
Varble N, Rajabzadeh-Oghaz H, Wang J, et al. Differences in morphologic and hemodynamic characteristics for “PHASES-Based” intracranial aneurysm locations. AJNR Am J Neuroradiol 2017; 38: 2105-2110.
23.
da Cunha CEG, da Cunha Correia C. Middle cerebral artery extension and the risk for aneurysmal disease. J Neurol Sci 2018; 390: 219-221.
24.
Kadkhodayan Y, Delgado Almandoz JE, Fease JL, et al. Endovascular treatment of 346 middle cerebral artery aneurysms: results of a 16-year single-center experience. Neurosurgery 2015; 76: 54-60; discussion 60-1.
25.
Kim KH, Cha KC, Kim JS, Hong SC. Endovascular coiling of middle cerebral artery aneurysms as an alternative to surgical clipping. J Clin Neurosci 2013; 20: 520-522.
26.
Abla AA, Jahshan S, Kan P, et al. Results of endovascular treatment of middle cerebral artery aneurysms after first giving consideration to clipping. Acta Neurochir (Wien) 2013; 155: 559-568.
27.
Vendrell JF, Menjot N, Costalat V, et al. Endovascular treatment of 174 middle cerebral artery aneurysms: clinical outcome and radiologic results at long-term follow-up. Radiology 2009; 253: 191-198.
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