Ahead of Print: Endovascular Treatment of 346 MCA Aneurysms

Background: The endovascular treatment of middle cerebral artery (MCA) aneurysms has been controversial due to the frequency of complex anatomy and relative ease of surgical clipping in this location.

Objective: To present a large single-center experience in the endovascular treatment of MCA aneurysms.

Methods: The neurointerventional database at our institution was reviewed for all endovascular treatments of MCA aneurysms. Demographics, aneurysm characteristics, treatment modality, intraprocedural hemorrhagic and thromboembolic events, 30-day neurological events, and follow-up angiographic studies were recorded.

Results: From December 1996 to April 2013, 292 patients underwent endovascular treatment of 346 MCA aneurysms. Of these, 341 were successfully completed (98.6%). Balloon neck remodeling was used in 230 procedures (66.5%). 95 procedures were for ruptured aneurysms (27.4%). The rate of intraprocedural hemorrhage was 2.6% (9 of 346). The overall rate of intraprocedural thromboembolic events was 13.6% (47 of 346), significantly more common in patients with acute subarachnoid hemorrhage (SAH, 27.4%, p < .001). The 30-day major (modified Rankin score > 2) neurological event rate was 2.9% (10 of 346), significantly more common in patients with SAH (8.4%) compared to those without (0.8%, p < .001). The rate of complete or near-complete aneurysm occlusion at >= 6 months was 90.6% and 91.8% at >= 2 years, with an average of 24 months follow-up available for 247 procedures.

Conclusion: Endovascular treatment of MCA aneurysms can be safe and effective. However, it is associated with a high asymptomatic thromboembolic event rate that is more frequent in the setting of acute SAH.

From: Endovascular Treatment of 346 MCA Aneurysms: Results of a 16-year Single Center Experience by Kadkhodayan et al.

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