Endovascular Treatment of Middle Cerebral Artery Aneurysms for 120 Nonselected Patients: A Prospective Cohort Study

BACKGROUND AND PURPOSE: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.MATERIALS AND METHODS: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.RESULTS: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%).CONCLUSIONS: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.

Endovascular treatment (EVT) of intracranial aneurysms is an established technique for both ruptured and unruptured aneurysms.^1,2 Nevertheless, many institutions still use surgical clipping (rather than coiling) as the first treatment for MCA aneurysms because they are accessible, even with complex anatomic features, which is not usually considered suitable for EVT with standard coiling.^3–5 In a systematic review of endovascular series of MCA aneurysms, the rates of combined permanent morbidity and mortality were 5.1% and 6.0% for unruptured and ruptured aneurysms, respectively.⁶ However, most of these series were highly focused on selected patients.^7–10 To date, with the advent of new endovascular tools such as balloons and stents designed specifically for the intracranial circulation, MCA aneurysms can be managed by means of the endovascular approach. However, the safety and efficacy of EVT for all patients are not well known yet.We assess the safety and the efficacy of a systematic endovascular approach in nonselected patients with MCA aneurysms in a prospective cohort. Predictors of complications, recanalization, and clinical outcome were determined.