Endovascular treatment of middle cerebral artery aneurysms for 120 nonselected patients: a prospective cohort study

• Published in: American journal of neuroradiology : AJNR Vol. 35; no. 4; pp. 715 - 720
• Main Authors: Gory, B, Rouchaud, A, Saleme, S, Dalmay, F, Riva, R, Caire, F, Mounayer, C
• Format: Journal Article
• Language: English
• Published: United States American Society of Neuroradiology 01.04.2014
• Subjects: Adult; Aged; Aged, 80 and over; Aneurysm, Ruptured - diagnostic imaging; Aneurysm, Ruptured - therapy; Cerebral Angiography; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Endovascular Procedures - methods; Female; Follow-Up Studies; Humans; Interventional; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - therapy; Life Sciences; Logistic Models; Male; Middle Aged; Multivariate Analysis; Prospective Studies; Registries; Santé publique et épidémiologie; Stents - adverse effects
• ISSN: 0195-6108; 1936-959X; 1936-959X
• DOI: 10.3174/ajnr.a3781

Multiple technologies have developed the endovascular approach to MCA aneurysms. We assess the safety and the efficacy of a systematic endovascular approach in nonselected patients with MCA aneurysms and determine predictors of treatment outcomes. We analyzed data collected between January 2007 and January 2012 in a prospective clinical registry. All patients with MCA aneurysms treated by means of the endovascular approach were included. A multivariate analysis was conducted to identify predictors of complications, recanalization, and outcome. A total of 120 patients with 131 MCA aneurysms were included. Seventy-nine patients (65.8%) were treated electively and 41 (34.2%) in the setting of subarachnoid hemorrhage. Thirty-three of 131 aneurysms (25.2%) were treated with simple coiling, 79 aneurysms (60.3%) with balloon-assisted coiling, and 19 aneurysms (14.5%) with stent-assisted coiling. Complications occurred in 13.7% of patients. Stent-assisted coiling was significantly associated with more complications (P = .002; OR: 4.86; 95% CI, 1.60-14.72). At 1 month after treatment, both the permanent morbidity (mRS ≤2) and mortality rates were 3.3%, without any significant difference according to the endovascular techniques. Mean angiographic follow-up was 16.3 months. The rate of recanalization was 15.6% without a statistical difference, according to the technique. Larger aneurysms were a predictor of recanalization (P = .016; OR: 1.183; 95% CI, 1.02-1.36). Retreatment was performed in 10 of 131 aneurysms (7.6%). Even though stent-assisted coiling significantly increases the risk of procedural complications, endovascular treatment of MCA aneurysms is safe, effective, and provides durable aneurysm closure in nonselected patients.