Background Recent data demonstrated that surgical clipping of the middle cerebral artery aneurysm may be superior to endovascular coiling when modified Rankin Scale (mRS) 2 or less is considered a good outcome. However, it is not clear that how many of the patients in both arms were able to go back to baseline functional states despite being independent. There are minimal data on the outcome of the repair of the MCA aneurysm when mRS 0–1 is considered a good outcome. Additionally, outcome of patients with a complex anatomy and/or wide neck are not well described.
Objectives Primary objective is to evaluate the functional outcomes of MCA aneurysm patients who underwent endovascular repair including those with wide neck and complex in nature. Secondary, objective is to determine the percentage of good outcome (mRS 0–2) patients who may return to the functional status (mRs 0–1).
Methods From a prospectively maintained database, consecutive patients with MCA aneurysm who underwent endovascular treatment were enrolled from 2011 to 2015. Patient’s demographics including perioperative events were captured. In addition to the long-term angiographic results, the functions outcome was measured using mRS in 90 days and subsequent visits.
Results 13 patients with median age 60 years (38–76), 83% women underwent endovascular repair of the 14 MCA aneurysms. Off 14 aneurysms (right 9) including 2 ruptured cases (11 were wide neck and 6 had complex anatomy), 11 required stent-assisted coiling representing one ruptured case. Stent was deployed in all but one case due to the extreme tortuosity, which underwent primary coiling of aneurysm. This 67 years old patient with 14 mm symptomatic right MCA aneurysm required treatment prior to initiate chemo and radiation therapy for her breast carcinoma. She developed intraoperative thrombosis of superior division of MCA which was recanalised using 10 mg of intra-arterial eptifibatide resulted in no clinical symptoms or radiographic stroke. Immediate complete and near complete obliteration was observed in 10 and subtotal in 4 cases. One patient lost long term follow-up. Off 4 subtotal cases; two achieved complete and 2 remain subtotal with improvement. Recurrence of aneurysm was observed in two cases that required subsequent coiling and achieve long-term complete obliteration. 90 days Independent functional outcome (mRS 0–2) was observed in all 13 patients including 2 ruptured cases. Long-term normal functional state (mRS 0–1) was observed in 11/12 cases and one ruptured patient remained in mRS 2 and was not able to go back to work.
Conclusions Endovascular repair of the MCA aneurysm inclosing those with wide neck and complex are not only safe and feasible, but associated with high long-term functional outcome. Therefore, endovascular options must be offered to patients prior to surgical clipping of a MCA aneurysm. Further study may be warranted.
Disclosures Y. Lodi: None. V. Reddy: None.
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