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

Clinical article

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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.

Article Information

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.

© AANS, except where prohibited by US copyright law.

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References

1

Bracard SLebedinsky AAnxionnat RNeto JMAudibert GLong Y: Endovascular treatment of Hunt and Hess grade IV and V aneurysms. AJNR Am J Neuroradiol 23:9539572002

2

Brilstra EHRinkel GJvan der Graaf Yvan Rooij WJAlgra A: Treatment of intracranial aneurysms by embolization with coils: a systematic review. Stroke 30:4704761999

3

Cognard CWeill ACastaings LRey AMoret J: Intracranial berry aneurysms: angiographic and clinical results after endovascular treatment. Radiology 206:4995101998

4

Cognard CWeill ASpelle LPiotin MCastaings LRey A: Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology 212:3483561999

5

Doerfler AWanke IGoericke SLWiedemayer HEngelhorn TGizewski ER: Endovascular treatment of middle cerebral artery aneurysms with electrolytically detachable coils. AJNR Am J Neuroradiol 27:5135202006

6

Fernandez Zubillaga AGuglielmi GVinuela FDuckwiler GR: Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. AJNR Am J Neuroradiol 15:815 8201994

7

Gallas SPasco ACottier JPGabrillargues JDrouineau JCognard C: A multicenter study of 705 ruptured intracranial aneurysms treated with Guglielmi detachable coils. AJNR Am J Neuroradiol 26:172317312005

8

Henkes HFischer SLiebig TWeber WReinartz JMiloslavski E: Repeated endovascular coil occlusion in 350 of 2759 intracranial aneurysms: safety and effectiveness aspects. Neurosurgery 58:2242322006

9

Henkes HFischer SWeber WMiloslavski EFelber SBrew S: Endovascular coil occlusion of 1811 intracranial aneurysms: early angiographic and clinical results. Neurosurgery 54:2682852004

10

Iijima APiotin MMounayer CSpelle LWeill AMoret J: Endovascular treatment with coils of 149 middle cerebral artery berry aneurysms. Radiology 237:6116192005

11

Molyneux AKerr RStratton ISandercock PClarke MShrimpton J: International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:126712742002

12

Murayama YVinuela FDuckwiler GRGobin YPGuglielmi G: Embolization of incidental cerebral aneurysms by using the Guglielmi detachable coil system. J Neurosurg 90:207 2141999

13

Ng PKhangure MSPhatouros CCBynevelt MApSimon HMcAuliffe W: Endovascular treatment of intracranial aneurysms with Guglielmi detachable coils: analysis of midterm angiographic and clinical outcomes. Stroke 33:2102172002

14

Park HKHorowitz MJungreis CGenevro JKoebbe CLevy E: Periprocedural morbidity and mortality associated with endovascular treatment of intracranial aneurysms. AJNR Am J Neuroradiol 26:5065142005

15

Quadros RSGallas SNoudel RRousseaux PPierot L: Endovascular treatment of middle cerebral artery aneurysms as first option: a single center experience of 92 aneurysms. AJNR Am J Neuroradiol 28:156715722007

16

Raymond JGuilbert FWeill AGeorganos SAJuravsky LLambert A: Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34:139814032003

17

Raymond JRoy D: Safety and efficacy of endovascular treatment of acutely ruptured aneurysms. Neurosurgery 41:1235 12361997

18

Roy DMilot GRaymond J: Endovascular treatment of unruptured aneurysms. Stroke 32:199820042001

19

Thornton JDebrun GMAletich VABashir QCharbel FTAusman J: Follow-up angiography of intracranial aneurysms treated with endovascular placement of Guglielmi detachable coils. Neurosurgery 50:2392502002

20

Vanzin JRMounayer CPiotin MSpelle LBoissonnet HMoret J: [Endovascular treatment of unruptured middle cerebral artery aneurysms.]. J Neuroradiol 32:971082005. (Fr)

21

Weir RUMarcellus MLDo HMSteinberg GKMarks 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 24:5855902003

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