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Original research
Endoluminal flow diverting stents for middle cerebral artery bifurcation aneurysms: multicenter cohort
  1. Mohamed M Salem1,2,
  2. Mirhojjat Khorasanizadeh1,
  3. Sovann V Lay3,
  4. Leonardo Renieri4,
  5. Anna L Kuhn5,
  6. Ahmad Sweid6,
  7. Francesco Massari5,
  8. Justin M Moore1,
  9. Stavropoula I. Tjoumakaris6,
  10. Pascal Jabbour6,
  11. Ajit S Puri5,
  12. Christopher S Ogilvy1,
  13. Brian T Jankowitz2,
  14. Jan-Karl Burkhardt2,
  15. Peter Kan7,
  16. Nicola Limbucci4,
  17. Christophe Cognard3,
  18. Ajith J Thomas1
  1. 1Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  2. 2Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
  3. 3Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France
  4. 4Department of Interventional Neuroradiology, University of Florence, Florence, Italy
  5. 5Division of Interventional Neuroradiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
  6. 6Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
  7. 7Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
  1. Correspondence to Dr Ajith J Thomas, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; athomas6{at}


Background Data regarding the safety and efficacy of flow diverting stents (FDS) in the treatment of middle cerebral artery (MCA) bifurcation aneurysms are scarce and limited to small single center series, with particular concern for increased risk of ischemic complications with jailing one of the M2 branches.

Methods Prospectively-maintained databases at six North American and European centers were queried for patients harboring MCA bifurcation aneurysms undergoing treatment with FDS (2011–2018). The pertinent clinical and radiographic data were collected and analyzed.

Results 87 patients (median age 60 years, 69% females) harboring 87 aneurysms were included. The majority of aneurysms were unruptured (79%); 75.9% were saccular with a median maximal diameter of 8.5 mm. Radiographic imaging follow-up was available in 88.5% of cases at a median of 16.3 months post-treatment, showing complete occlusion in 59% and near complete occlusion (90–99%) in 18% of aneurysms. The overall rate of ischemic and hemorrhagic complications was 8% and 1.1%, respectively. Symptomatic and permanent complications were encountered in 5.7% and 2.3% of patients respectively, with retreatment pursued in 2.3% of patients. Jailed branch occlusion was detected in 11.5% of cases, with clinical sequelae in 2.3%. Last follow-up modified Rankin Scale of 0–2 was noted in 96.8% of patients. On multivariate analysis, male sex was the only independent predictor of aneurysmal persistence at last follow-up imaging (p=0.019).

Conclusion FDS treatment for MCA bifurcation aneurysms is feasible, with comparable safety and efficacy profiles to other available endovascular options when utilized in carefully selected aneurysms. Jailing of M2 branches was not associated with a higher risk of post-procedural ischemic complications.

  • aneurysm
  • flow diverter
  • stroke

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Twitter @PascalJabbourMD, @PeterKa80460001

  • Contributors All authors contributed to the study conception and design and/or data acquisition. The conception of the idea was done by AJ and MMS. Literature review and data extraction were performed by MMS and MK. The first draft of the paper was done by MMS and MK. All authors have contributed to the editing of prior versions, read and approved the final version of the manuscript. AJT is the guarantor of the work and accepts full responsibility for the conduction of the study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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