Stent-assisted embolization of 100 middle cerebral artery aneurysms

Clinical article

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Object

The introduction of intracranial stents to aneurysm treatment allows endovascular repair of nearly all aneurysms, but the safety and durability of stent-assisted embolization of middle cerebral artery (MCA) aneurysms is unclear.

Methods

Ninety-one patients with 100 complex MCA aneurysms not amenable to simple coiling were treated with stent-assisted embolization as a first option. Technical and clinical results, initial follow-up imaging, and long-term annual MR angiography (MRA) were reviewed.

Results

Intracranial stents were successfully deployed in all 100 aneurysms. There was 1 case of significant neurological morbidity (1%) and 1 case of death (1%) related to treatment. Initial posttreatment angiography revealed complete occlusion of 48 aneurysms (48%), a residual neck in 21 (21%), and residual aneurysm filling in 31 (31%). Follow-up imaging performed in 85 (90.4%) of a possible 94 aneurysms showed complete occlusion of 77 aneurysms (90.6%), residual neck in 3 (3.5%), and residual filling in 5 (5.9%). Four aneurysms (4.7%) required retreatment. Long-term MRA follow-up revealed stability or progressive thrombosis in 47 (97.9%) of 48 aneurysms. In 11 patients Y-configuration stenting caused only 1 minor complication and provided durable occlusion in all cases.

Conclusions

Stent-assisted techniques increase the number of aneurysms that may be treated endovascularly and represent an acceptable alternative to craniotomy. Stents provided adequate vessel reconstruction, low complication rates, and good long-term occlusion.

Abbreviations used in this paper:MCA = middle cerebral artery; MRA = MR angiography.

Article Information

Address correspondence to: Demetrius K. Lopes, M.D., Department of Neurological Surgery, Rush University Medical Center, 1725 West Harrison Street, Suite 1115, Chicago, Illinois 60612. email: brainaneurysm@mac.com.

Please include this information when citing this paper: published online February 8, 2013; DOI: 10.3171/2013.1.JNS121298.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    DynaCT (Siemens) oblique axial reconstructed scan showing Y-configuration stenting of an MCA aneurysm using Neuroform stents; the anterior communicating artery aneurysm is covered by a single Neuroform stent.

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    Left: Anteroposterior digital subtraction angiogram showing an M1 segment aneurysm treated with overlapping stents and coil embolization. Right: Magnetic resonance angiogram demonstrating new filling at the site of the aneurysm 3 years after treatment. This unusual case of either recurrence or adjacent de novo aneurysm formation was treated with coil embolization delivered through the struts of the existing stents.

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