Feasibility and Midterm Outcomes of Endovascular Coil Embolization of an Unruptured Middle Cerebral Artery Aneurysm with an Incorporated Branch

• Published in: World neurosurgery Vol. 118; pp. e745 - e752
• Main Authors: Kim, Jonghoon, Chang, Chulhoon, Jung, Youngjin
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2018
• Subjects: Adult; Aged; Blood Vessel Prosthesis; Cerebral Angiography - methods; Embolization; Embolization, Therapeutic - instrumentation; Embolization, Therapeutic - methods; Feasibility Studies; Female; Humans; Intracranial aneurysm; Intracranial Aneurysm - surgery; Male; Middle Aged; Middle cerebral artery; Retrospective Studies; Therapeutic; Treatment Outcome; Embolization; Therapeutic; MCA; Intracranial aneurysm; Middle cerebral artery
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.07.031

Endovascular coiling has emerged as an option for the management of unruptured intracranial aneurysms, which was traditionally treated via surgical clipping. Unlike aneurysms elsewhere, aneurysms of the middle cerebral artery (MCA) have several features that are favorable for surgery. However, endovascular treatment can be difficult for MCA aneurysms, especially if they have incorporated branches. We report the results of coil embolization of incorporated MCA aneurysms. From 2012 to 2017, 129 unruptured aneurysms including 10 incorporated MCA aneurysms were treated. The mean neck, height, and width of the aneurysms were 3.74 ± 1.07, 4.26 ± 1.06, and 3.97 ± 1.03, respectively. The mean aspect ratio, neck/sac width, and sac width/neck were 1.19 ± 0.37, 1.09 ± 0.21, and 0.95 ± 0.18, respectively. Nine cases of incorporated MCA aneurysms were treated using the double microcatheter technique, whereas the triple microcatheter technique was used in 1 case. There were no procedure-related complications. Postcoiling angiograms showed that 4 aneurysms achieved complete occlusion (40%), 5 had a remnant neck (50%), and 1 had a remnant sac (10%). During the follow-up period, (26.0 ± 4.5 months; range, 3–49 months), there were no incidents of recurrence and bleeding. One patient experienced a small cerebral infarction 1 month after the procedure, but it did not lead to any permanent neurologic deficits. Branch-incorporated MCA aneurysms can be treated with coil embolization, with few procedural complications and midterm durability with appropriate techniques and devices. •The MCA aneurysm is not suitable for coil embolization if it has incorporated branches.•However, with the development of devices and coiling techniques, these lesions can also be coiled.•During the last 6 years (2012–2017), unruptured 10 incorporated MCA aneurysms were treated.•In 9 cases treated with the double microcatheter technique and the triple microcatheter technique was used in 1 case.•Branch-incorporated MCA aneurysms can be treated with coil embolization.