Background Neuroendovascular approach of aneurysm treatment continues to gain popularity and has been preferred by patients’ due to short hospital stays with early return to the daily activities of living. However, middle cerebral artery aneurysms (MCA) are still favored for open craniotomy. Data on early discharge and complete return to full functionality after MCA aneurysm repair are lacking. Additionally, endovascular outcome of patients with a complex anatomy and/or wide neck are not well described.
Objectives To evaluate the technical and long-term durable outcomes of patients with MCA aneurysm who were repaired in endovascular approach. Additionally, to determine the average hospital stay and early return to previous daily activities of living.
Methods Consecutive patients who underwent endovascular repair of the MCA aneurysm from January 2011 to December 2017 were enrolled and data was retrospectively analyzed. Antiplatelet loading regimen: stent assisted coiling; Plavix 75 mg × 4 and rapid release chewable baby aspirin 81 mg × 4. Coiling; chewable aspirin 81 mg × 4, both cases given at least 4 hours prior. Overpacking and primary coiling cases received additional 300 mg rectal aspiring immediate after the procedure. Heparin was administered for all stent-assisted and primary coiling cases prior to deployment of stent or coil with target 1.5 −2 × 2 baseline activated coagulation time. Ruptured primary coiling; heparin was administered after the deployment of first coil. Patients long-term outcome was measure using modified Rankin Scale (mRS).
Results 24 patients with median age of 61.5 years (38 to 78) with 26 MCA aneurysms underwent endovascular repair; Right MCA 19, wide neck and complex anatomy 19, ruptured 2, symptomatic 12, recurrent 3 and asymptomatic 9. Primary coiling was performed in 10 aneurysms; 6 small neck, 2 ruptured with 1 wide neck, and 2 unsuccessful attempted stent-assisted aneurysms. Stent-assisted coiling was intended in 18 but performed in 16 cases; unable to access M2 in one and faulty stent deployment in one. Intra-operative asymptomatic left M2 occlusion developed in one which was corrected using intra-arterial integrilin and achieved baseline mRS1. Clinical events in 2; subarachnoid hemorrhage in one after unsuccessful attempted M2 catheterization for stenting. Patient discharged home in 48 hours and achieved mRS 0. Post procedure temporal lobe stroke in other in primary coiling group, who had significant vascular risk factors and didn’t receive antiplatelet before or after the procedure. Immediate complete and near complete obliteration of aneurysm achieved in 23 aneurysms (88.5%) and 3 had subtotal obliteration (11.5%). Median 18 months aneurysm obliteration: complete and near-complete in 20 (77%), recurrence in 3 (11.5%) and subtotal in 3 (11.5%). Recurrent and subtotal cases were repaired with persistent obliteration. Median hospital stay was 1.4 days (1–7 days) excluding 2 ruptured cases. 90 days mRS 0 in 16 and mRS 1in 5 (87.5%) and mRS 2 in 2 patients (both has baseline mRS 2).
Conclusions Our series demonstrates that MCA aneurysms could be safely repaired by endovascular approach including those with wide neck and complex morphology. Additionally, early return home and achieving full functionalities are possible. Further studies are needed.
Disclosures Y. Lodi: None. A. Hourani: None. V. Reddy: None. S. Javed: None. S. Multani: None. T. Wang: None.
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