Introduction Middle cerebral artery (MCA) aneurysms are eligible for both treatment options (microsurgery and embolization). The purposes of our study were 1) to evaluate the morbi-mortality rate related to endovascular and microsurgical treatments of ruptured and unruptured MCA aneurysms and 2) to study the effectiveness of endovascular and surgical treatments for these aneurysms in terms of recanalization/recurrence and bleeding at short and long terms angiographic and clinical follow-ups.
Material and methods Our study is a mono-centric retrospective observational study, reporting clinical and angiographic follow-up of consecutive patients treated for MCA aneurysms (ruptured and unruptured). From 2002 to 2012, 362 consecutive patients were admitted at our institution for the treatment of 390 MCA aneurysms (255 ruptured and 135 unruptured). Among the procedures, 127 aneurysms were treated by endovascular means (32.5%) and 263 (67.5%) by microsurgery. Procedure-related death and complications (major/minor) were systematically assessed. The per-procedural rupture rate was also evaluated. The quality of the aneurysms exclusion was evaluated according to the Roy-Raymond scale in post-procedure and at long term angiographic follow-up (mean delay = 36 months).
Results Procedure related death rate was 1.9%. This rate was slightly higher in the group of ruptured aneurysms treated by endovascular (EV) means (3.2% vs 1.2% in the group S [Surgery]), but this difference was not significant (p = 0.23). The procedure-related major complication rate was slightly higher in the group S (5.6% vs 2.4% for the group EV; p = 0.19, non-significant). Minor complications were slightly more frequent in the group S (5.6% vs 4.8% for the group EV), but this difference was also not statistically significant (p = 1). Per-procedure rupture rate was 14.4%; per-procedure ruptures were more frequently observed for ruptured aneurysms treated by microsurgery.
During the hospital stay, 69% of the patients with ruptured aneurysms had a favorable outcome (mRS ≤ 3); this rate increased to 72.9% at 6 months and 72.3% at 12 months follow-up.
In post-procedure, Roy-Raymond grade A or B occlusion rate was 94.8% for the overall population; this rate was similar for the group S and the group EV (95.6% for the group S vs 92.2% for the group EV; NS). However, long-term angiographic follow-up showed a higher Roy-Raymond grade A or B for the group S (94.2% for the group S vs 78% for the group EV [p < 0.01]). Recurrence rate was 15.1% in the overall population: 0% in the group S vs 28.6% in the group EV (p < 0.001). Nevertheless, no bleeding or rebleeding was noticed during the long-term (mean delay = 83.5 months) imaging and clinical follow-up in both groups S and EV.
Conclusion Both microsurgical and endovascular techniques are safe for the treatment of MCA aneurysms, with an acceptable complication rate (overall morbi-mortality rate: 5.6%). The two techniques allow for a satisfactory exclusion of aneurysm. However, long-term angiographic follow-up showed more stable results for the surgical treatment, but without bleeding/rebleeding event observed during the long-term clinical follow-up for both techniques.
Disclosures N. Sourour: 2; C; eV3/Covidien. S. Hallout: None. F. Di Maria: None. A. Nouet: None. J. Gabrieli: None. P. Cornu: None. J. Chiras: None. F. Clarençon: None.
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