Endovascular coil occlusion of 152 middle cerebral artery aneurysms: initial and midterm angiographic and clinical results

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  • 1 Departments of Diagnostic and Interventional Neuroradiology and
  • 3 Neurosurgery, Centre Hospitalier Universitaire Nancy; and
  • 2 Institut National de la Santé et de la Recherche Médicale Unit 947, University Nancy 1, Nancy, France
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Object

The object of this study was to evaluate the initial and mid-term angiographic and clinical results after endovascular coil occlusion of middle cerebral artery (MCA) aneurysms at the authors' institution.

Methods

The authors conducted a retrospective analysis of a consecutive series of 152 MCA aneurysms (73 ruptured) treated by endovascular coiling in 140 patients. Angiographic and clinical data at initial and midterm follow-up as well as procedure-related complications were prospectively registered.

Results

At discharge, favorable clinical outcomes (Glasgow Outcome Scale score of 1 or 2) were obtained in 89.3% of patients (125/140). Seven patients (5%) were in a vegetative state or had died. Complications were encountered in association with 11.8% of the procedures (18/152), and most (13/18) involved thromboembolic events (which led to permanent ischemia in 4 cases and death in 1). The overall procedure-related mortality rate was 0.7%, and the rates of permanent and transient morbidity were 2.6 and 2%, respectively. At a mean follow-up duration of 4.3 years there had been 4 cases of rebleeding: early rebleeding occurred during the initial postoperative period in 3 cases and later in 1. Total or subtotal occlusion was obtained in 84.2% of aneurysms (128/152). At follow-up, this satisfactory occlusion persisted in 83.3% of aneurysms (110/132) at 1 year posttreatment, 79.5% (89/112) at 3 years, and 80.2% (73/91) at 5 years.

Conclusions

Risks and initial and midterm angiographic and clinical results after endovascular treatment of MCA aneurysms are nearly identical to other locations. Endovascular treatment may thus be proposed as an alternative to surgical clipping at this location. Nevertheless, a longer follow-up period is necessary to determine its efficacy, particularly in cases of unruptured aneurysms.

Abbreviations used in this paper: EVT = endovascular treatment; GOS = Glasgow Outcome Scale; MCA = middle cerebral artery.

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Contributor Notes

Address correspondence to: Serge Bracard, M.D., Service de Neuroradiologie, Hôpital central, CHU Nancy, 29 avenue de Lattre de Tassigny, 54035 Nancy, France. email: s.bracard@gmail.com.

Please include this information when citing this paper: published online October 23, 2009; DOI: 10.3171/2009.6.JNS09483.

  • 1

    Bracard S, , Lebedinsky A, , Anxionnat R, , Neto JM, , Audibert G, & Long Y, : Endovascular treatment of Hunt and Hess grade IV and V aneurysms. AJNR Am J Neuroradiol 23:953957, 2002

    • Search Google Scholar
    • Export Citation
  • 2

    Brilstra EH, , Rinkel GJ, , van der Graaf Y, , van Rooij WJ, & Algra A: Treatment of intracranial aneurysms by embolization with coils: a systematic review. Stroke 30:470476, 1999

    • Search Google Scholar
    • Export Citation
  • 3

    Cognard C, , Weill A, , Castaings L, , Rey A, & Moret J: Intracranial berry aneurysms: angiographic and clinical results after endovascular treatment. Radiology 206:499510, 1998

    • Search Google Scholar
    • Export Citation
  • 4

    Cognard C, , Weill A, , Spelle L, , Piotin M, , Castaings L, & Rey A, : Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology 212:348356, 1999

    • Search Google Scholar
    • Export Citation
  • 5

    Doerfler A, , Wanke I, , Goericke SL, , Wiedemayer H, , Engelhorn T, & Gizewski ER, : Endovascular treatment of middle cerebral artery aneurysms with electrolytically detachable coils. AJNR Am J Neuroradiol 27:513520, 2006

    • Search Google Scholar
    • Export Citation
  • 6

    Fernandez Zubillaga A, , Guglielmi G, , Vinuela F, & Duckwiler GR: Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. AJNR Am J Neuroradiol 15:815 820, 1994

    • Search Google Scholar
    • Export Citation
  • 7

    Gallas S, , Pasco A, , Cottier JP, , Gabrillargues J, , Drouineau J, & Cognard C, : A multicenter study of 705 ruptured intracranial aneurysms treated with Guglielmi detachable coils. AJNR Am J Neuroradiol 26:17231731, 2005

    • Search Google Scholar
    • Export Citation
  • 8

    Henkes H, , Fischer S, , Liebig T, , Weber W, , Reinartz J, & Miloslavski E, : Repeated endovascular coil occlusion in 350 of 2759 intracranial aneurysms: safety and effectiveness aspects. Neurosurgery 58:224232, 2006

    • Search Google Scholar
    • Export Citation
  • 9

    Henkes H, , Fischer S, , Weber W, , Miloslavski E, , Felber S, & Brew S, : Endovascular coil occlusion of 1811 intracranial aneurysms: early angiographic and clinical results. Neurosurgery 54:268285, 2004

    • Search Google Scholar
    • Export Citation
  • 10

    Iijima A, , Piotin M, , Mounayer C, , Spelle L, , Weill A, & Moret J: Endovascular treatment with coils of 149 middle cerebral artery berry aneurysms. Radiology 237:611619, 2005

    • Search Google Scholar
    • Export Citation
  • 11

    Molyneux A, , Kerr R, , Stratton I, , Sandercock P, , Clarke M, & Shrimpton J, : International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:12671274, 2002

    • Search Google Scholar
    • Export Citation
  • 12

    Murayama Y, , Vinuela F, , Duckwiler GR, , Gobin YP, & Guglielmi G: Embolization of incidental cerebral aneurysms by using the Guglielmi detachable coil system. J Neurosurg 90:207 214, 1999

    • Search Google Scholar
    • Export Citation
  • 13

    Ng P, , Khangure MS, , Phatouros CC, , Bynevelt M, , ApSimon H, & McAuliffe W: Endovascular treatment of intracranial aneurysms with Guglielmi detachable coils: analysis of midterm angiographic and clinical outcomes. Stroke 33:210217, 2002

    • Search Google Scholar
    • Export Citation
  • 14

    Park HK, , Horowitz M, , Jungreis C, , Genevro J, , Koebbe C, & Levy E, : Periprocedural morbidity and mortality associated with endovascular treatment of intracranial aneurysms. AJNR Am J Neuroradiol 26:506514, 2005

    • Search Google Scholar
    • Export Citation
  • 15

    Quadros RS, , Gallas S, , Noudel R, , Rousseaux P, & Pierot L: Endovascular treatment of middle cerebral artery aneurysms as first option: a single center experience of 92 aneurysms. AJNR Am J Neuroradiol 28:15671572, 2007

    • Search Google Scholar
    • Export Citation
  • 16

    Raymond J, , Guilbert F, , Weill A, , Georganos SA, , Juravsky L, & Lambert A, : Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34:13981403, 2003

    • Search Google Scholar
    • Export Citation
  • 17

    Raymond J, & Roy D: Safety and efficacy of endovascular treatment of acutely ruptured aneurysms. Neurosurgery 41:1235 1236, 1997

  • 18

    Roy D, , Milot G, & Raymond J: Endovascular treatment of unruptured aneurysms. Stroke 32:19982004, 2001

  • 19

    Thornton J, , Debrun GM, , Aletich VA, , Bashir Q, , Charbel FT, & Ausman J: Follow-up angiography of intracranial aneurysms treated with endovascular placement of Guglielmi detachable coils. Neurosurgery 50:239250, 2002

    • Search Google Scholar
    • Export Citation
  • 20

    Vanzin JR, , Mounayer C, , Piotin M, , Spelle L, , Boissonnet H, & Moret J: [Endovascular treatment of unruptured middle cerebral artery aneurysms.]. J Neuroradiol 32:97108, 2005. (Fr)

    • Search Google Scholar
    • Export Citation
  • 21

    Weir RU, , Marcellus ML, , Do HM, , Steinberg GK, & Marks MP: Aneurysmal subarachnoid hemorrhage in patients with Hunt and Hess grade 4 or 5: treatment using the Guglielmi detachable coil system. AJNR Am J Neuroradiol 24:585590, 2003

    • Search Google Scholar
    • Export Citation

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