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Endovascular treatment of middle cerebral artery aneurysms: A single center experience with a focus on thromboembolic complications.

TitleEndovascular treatment of middle cerebral artery aneurysms: A single center experience with a focus on thromboembolic complications.
Publication TypeJournal Article
Year of Publication2018
AuthorsLink TW, Boddu SR, Hammad HT, Knopman J, Lin N, Gobin P, Patsalides A
JournalInterv Neuroradiol
Volume24
Issue1
Pagination14-21
Date Published2018 Feb
ISSN2385-2011
KeywordsAdolescent, Adult, Aged, Aged, 80 and over, Cerebral Angiography, Endovascular Procedures, Female, Humans, Infarction, Middle Cerebral Artery, Intracranial Aneurysm, Intracranial Thrombosis, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Treatment Outcome
Abstract

Background Endovascular treatment of middle cerebral artery (MCA) aneurysms has traditionally been considered difficult due to complex branching patterns, frequent involvement of parent vessels within the aneurysm neck, and a high incidence of thromboembolic complications. Methods The cases of 93 MCA aneurysms treated with endovascular intervention at our institution between 2003 and 2015 were retrospectively reviewed. Demographic, clinical, and radiographic variables were recorded and analyzed. Results Immediate complete or near-complete occlusion was achieved in 81 (90%) cases. At the longest follow up of 6 months or greater, 83.3% of the aneurysms were stable-to-improved in the Raymond occlusion classification, 8.3% were found to have minor recanalization not requiring retreatment, and 8.3% required retreatment due to significant recanalization. Thromboembolic events occurred in 18 (19.3%) of cases, but only 1 resulted in permanent vessel occlusion and only 1 resulted in permanent neurologic impairment. Thrombus was resolved with intra-arterial thrombolysis or mechanical thrombectomy in 17 of the 18 cases. There were only two cases resulting in morbidity (2.15%). There was no statistically significant correlation between aneurysm location, size, morphology, or use of adjuvant device with radiographic outcome or thromboembolic event. Conclusions While the rate of thromboembolic events in our series was 19%, the overall morbidity was only 2%. This highlights the fact that even complex MCA aneurysms can safely and effectively be treated by endovascular means with or without the use of balloon or stent assistance, as long as the interventionalist is astutely aware of the possibility of thrombus formation and acts accordingly with thrombolytic therapy when necessary.

DOI10.1177/1591019917738961
Alternate JournalInterv Neuroradiol
PubMed ID29086624
PubMed Central IDPMC5772541