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Abstract
Introduction Middle cerebral artery (MCA) aneurysms have conventionally been considered better suited for clipping rather than coiling. We evaluated occlusion and complication rates from treating MCA aneurysms with endovascular methods and compared our recent experience to an earlier time period.
Methods 124 patients with 126 MCA aneurysms treated endovascularly at our institution from April 2009 – May of 2017 were retrospectively studied. Patient demographics, details of the endovascular treatment, angiographic outcome, and all adverse events were recorded. The patients were split into two cohorts, one spanning form April 2009 to December 31, 2013 and one from January 1 2014 to May 2017.
Results Overall, 42 (33%) of the treated aneurysms were ruptured. Unassisted coiling was possible in 36 cases (29%) while adjuncts for coil embolization were employed in 90 of the cases (71%). Raymond 1oc and 2oc clusion was achieved in 94% of patients at 6–12 month follow up angiogram. Complication rates improved over time for both major complications (stroke/permanent neurologic deficit) and minor complications (TIAs or asymptomatic intraprocedural thrombus). Patients treated prior to 2014 resulted in 8 (11%) major complications and 9 (12%) minor complications. Patients treated after to 2014 resulted in 3 (6%) major complications and 4 (8%) minor complications.
Conclusions Endovascular treatment of MCA aneurysms remains challenging but has progressed over the last few years with improvement in devices and better understanding the unique anatomical challenges. Although high occlusion rates were achieved throughout the period reviewed, safety issues during early experience resulted in higher than expected rate of intraprocedural thrombus formation, TIAs and permanent neurologic deficits. Our more recent results demonstrate improved safety profiles are achievable by identifying risk factors for thrombus formation, early use of adjunctive devices for complication avoidance, and recent development of more suitable devices for these aneurysms. These results match publications reported for large clipping cohorts.
Disclosures R. Kellogg: None. I. Chaudry: None. A. Turk: None. R. Turner: None. A. Spiotta: None.