Results of endovascular treatment of middle cerebral artery aneurysms after first giving consideration to clipping

Adib A. Abla, Shady Jahshan, Peter Kan, Maxim Mokin, Travis M Dumont, Jorge L. Eller, Kenneth V. Snyder, L. Nelson Hopkins, Adnan H. Siddiqui, Elad I. Levy

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Middle cerebral artery (MCA) aneurysms are among the more challenging aneurysms for endovascular treatment. We report a contemporary 5-year experience with endovascular therapy for MCA aneurysms at a high-volume neurovascular center. Methods: Review of prospectively maintained intracranial aneurysm database. Results: Between 2005 and 2009, 148 patients underwent treatment of 149 MCA aneurysms at our hospital, of which 33 patients with 34 aneurysms underwent endovascular therapy. Among these 33 patients, 14 presented with subarachnoid hemorrhage. Eleven patients were treated with stent-assisted coiling, 1 with balloon-assisted coiling, and the remainder with coiling alone. Three patients required repeat endovascular treatment. There were 7 periprocedural complications, including intraprocedural aneurysm rupture resulting in death in 2 patients. Two patients died at later dates from remote aneurysm rehemorrhage. Average follow-up of remaining patients was 17.1 months radiographically, and 20.3 months clinically. Average modified Rankin scale (mRS) score at last follow up was 2.09, with 17 patients with mRS 0/1 and 5 patients with mRS 2. Fifteen patients showed evidence of radiographic residual at last follow up: 13 were simple neck residuals. Unruptured status and saccular aneurysms were associated with mRS 0/1 outcome (each p < 0.05). Conclusions: At our hospital, MCA aneurysms are being treated with endovascular techniques, but in a minority of patients. Despite the rate of residual neck remnants, few retreatments were necessary and few rehemorrhages occurred. The periprocedural complication rate was not insignificant; therefore, in more recent years and at present, most MCA aneurysms are considered for clipping first at our center.

Original languageEnglish (US)
Pages (from-to)559-568
Number of pages10
JournalActa Neurochirurgica
Volume155
Issue number4
DOIs
StatePublished - Apr 2013
Externally publishedYes

Fingerprint

Intracranial Aneurysm
Aneurysm
Therapeutics
Neck
Endovascular Procedures
Retreatment
Subarachnoid Hemorrhage
Stents
Rupture
Databases

Keywords

  • Clipping
  • Coil embolization
  • Endovascular technique
  • Intracranial aneurysm
  • Middle cerebral artery

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Results of endovascular treatment of middle cerebral artery aneurysms after first giving consideration to clipping. / Abla, Adib A.; Jahshan, Shady; Kan, Peter; Mokin, Maxim; Dumont, Travis M; Eller, Jorge L.; Snyder, Kenneth V.; Hopkins, L. Nelson; Siddiqui, Adnan H.; Levy, Elad I.

In: Acta Neurochirurgica, Vol. 155, No. 4, 04.2013, p. 559-568.

Research output: Contribution to journalArticle

Abla, AA, Jahshan, S, Kan, P, Mokin, M, Dumont, TM, Eller, JL, Snyder, KV, Hopkins, LN, Siddiqui, AH & Levy, EI 2013, 'Results of endovascular treatment of middle cerebral artery aneurysms after first giving consideration to clipping', Acta Neurochirurgica, vol. 155, no. 4, pp. 559-568. https://doi.org/10.1007/s00701-012-1594-8
Abla, Adib A. ; Jahshan, Shady ; Kan, Peter ; Mokin, Maxim ; Dumont, Travis M ; Eller, Jorge L. ; Snyder, Kenneth V. ; Hopkins, L. Nelson ; Siddiqui, Adnan H. ; Levy, Elad I. / Results of endovascular treatment of middle cerebral artery aneurysms after first giving consideration to clipping. In: Acta Neurochirurgica. 2013 ; Vol. 155, No. 4. pp. 559-568.
@article{0323833791484909867e0b45166f3927,
title = "Results of endovascular treatment of middle cerebral artery aneurysms after first giving consideration to clipping",
abstract = "Background: Middle cerebral artery (MCA) aneurysms are among the more challenging aneurysms for endovascular treatment. We report a contemporary 5-year experience with endovascular therapy for MCA aneurysms at a high-volume neurovascular center. Methods: Review of prospectively maintained intracranial aneurysm database. Results: Between 2005 and 2009, 148 patients underwent treatment of 149 MCA aneurysms at our hospital, of which 33 patients with 34 aneurysms underwent endovascular therapy. Among these 33 patients, 14 presented with subarachnoid hemorrhage. Eleven patients were treated with stent-assisted coiling, 1 with balloon-assisted coiling, and the remainder with coiling alone. Three patients required repeat endovascular treatment. There were 7 periprocedural complications, including intraprocedural aneurysm rupture resulting in death in 2 patients. Two patients died at later dates from remote aneurysm rehemorrhage. Average follow-up of remaining patients was 17.1 months radiographically, and 20.3 months clinically. Average modified Rankin scale (mRS) score at last follow up was 2.09, with 17 patients with mRS 0/1 and 5 patients with mRS 2. Fifteen patients showed evidence of radiographic residual at last follow up: 13 were simple neck residuals. Unruptured status and saccular aneurysms were associated with mRS 0/1 outcome (each p < 0.05). Conclusions: At our hospital, MCA aneurysms are being treated with endovascular techniques, but in a minority of patients. Despite the rate of residual neck remnants, few retreatments were necessary and few rehemorrhages occurred. The periprocedural complication rate was not insignificant; therefore, in more recent years and at present, most MCA aneurysms are considered for clipping first at our center.",
keywords = "Clipping, Coil embolization, Endovascular technique, Intracranial aneurysm, Middle cerebral artery",
author = "Abla, {Adib A.} and Shady Jahshan and Peter Kan and Maxim Mokin and Dumont, {Travis M} and Eller, {Jorge L.} and Snyder, {Kenneth V.} and Hopkins, {L. Nelson} and Siddiqui, {Adnan H.} and Levy, {Elad I.}",
year = "2013",
month = "4",
doi = "10.1007/s00701-012-1594-8",
language = "English (US)",
volume = "155",
pages = "559--568",
journal = "Acta Neurochirurgica",
issn = "0001-6268",
publisher = "Springer Wien",
number = "4",

}

TY - JOUR

T1 - Results of endovascular treatment of middle cerebral artery aneurysms after first giving consideration to clipping

AU - Abla, Adib A.

AU - Jahshan, Shady

AU - Kan, Peter

AU - Mokin, Maxim

AU - Dumont, Travis M

AU - Eller, Jorge L.

AU - Snyder, Kenneth V.

AU - Hopkins, L. Nelson

AU - Siddiqui, Adnan H.

AU - Levy, Elad I.

PY - 2013/4

Y1 - 2013/4

N2 - Background: Middle cerebral artery (MCA) aneurysms are among the more challenging aneurysms for endovascular treatment. We report a contemporary 5-year experience with endovascular therapy for MCA aneurysms at a high-volume neurovascular center. Methods: Review of prospectively maintained intracranial aneurysm database. Results: Between 2005 and 2009, 148 patients underwent treatment of 149 MCA aneurysms at our hospital, of which 33 patients with 34 aneurysms underwent endovascular therapy. Among these 33 patients, 14 presented with subarachnoid hemorrhage. Eleven patients were treated with stent-assisted coiling, 1 with balloon-assisted coiling, and the remainder with coiling alone. Three patients required repeat endovascular treatment. There were 7 periprocedural complications, including intraprocedural aneurysm rupture resulting in death in 2 patients. Two patients died at later dates from remote aneurysm rehemorrhage. Average follow-up of remaining patients was 17.1 months radiographically, and 20.3 months clinically. Average modified Rankin scale (mRS) score at last follow up was 2.09, with 17 patients with mRS 0/1 and 5 patients with mRS 2. Fifteen patients showed evidence of radiographic residual at last follow up: 13 were simple neck residuals. Unruptured status and saccular aneurysms were associated with mRS 0/1 outcome (each p < 0.05). Conclusions: At our hospital, MCA aneurysms are being treated with endovascular techniques, but in a minority of patients. Despite the rate of residual neck remnants, few retreatments were necessary and few rehemorrhages occurred. The periprocedural complication rate was not insignificant; therefore, in more recent years and at present, most MCA aneurysms are considered for clipping first at our center.

AB - Background: Middle cerebral artery (MCA) aneurysms are among the more challenging aneurysms for endovascular treatment. We report a contemporary 5-year experience with endovascular therapy for MCA aneurysms at a high-volume neurovascular center. Methods: Review of prospectively maintained intracranial aneurysm database. Results: Between 2005 and 2009, 148 patients underwent treatment of 149 MCA aneurysms at our hospital, of which 33 patients with 34 aneurysms underwent endovascular therapy. Among these 33 patients, 14 presented with subarachnoid hemorrhage. Eleven patients were treated with stent-assisted coiling, 1 with balloon-assisted coiling, and the remainder with coiling alone. Three patients required repeat endovascular treatment. There were 7 periprocedural complications, including intraprocedural aneurysm rupture resulting in death in 2 patients. Two patients died at later dates from remote aneurysm rehemorrhage. Average follow-up of remaining patients was 17.1 months radiographically, and 20.3 months clinically. Average modified Rankin scale (mRS) score at last follow up was 2.09, with 17 patients with mRS 0/1 and 5 patients with mRS 2. Fifteen patients showed evidence of radiographic residual at last follow up: 13 were simple neck residuals. Unruptured status and saccular aneurysms were associated with mRS 0/1 outcome (each p < 0.05). Conclusions: At our hospital, MCA aneurysms are being treated with endovascular techniques, but in a minority of patients. Despite the rate of residual neck remnants, few retreatments were necessary and few rehemorrhages occurred. The periprocedural complication rate was not insignificant; therefore, in more recent years and at present, most MCA aneurysms are considered for clipping first at our center.

KW - Clipping

KW - Coil embolization

KW - Endovascular technique

KW - Intracranial aneurysm

KW - Middle cerebral artery

UR - http://www.scopus.com/inward/record.url?scp=84876672355&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84876672355&partnerID=8YFLogxK

U2 - 10.1007/s00701-012-1594-8

DO - 10.1007/s00701-012-1594-8

M3 - Article

VL - 155

SP - 559

EP - 568

JO - Acta Neurochirurgica

JF - Acta Neurochirurgica

SN - 0001-6268

IS - 4

ER -