• Journal of neurosurgery · Apr 2010

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

    • Serge Bracard, Amr Abdel-Kerim, Lorrena Thuillier, Olivier Klein, René Anxionnat, Stefanos Finitsis, Ariel Lebedinsky, Clayton Maceido de Freitas, Nilson Pinheiro, Guillerme Cabral de Andrade, and Luc Picard.
    • Department of Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire Nancy, Nancy, France. s.bracard@gmail.com
    • J. Neurosurg. 2010 Apr 1; 112 (4): 703-8.

    ObjectThe 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.MethodsThe 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.ResultsAt 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.ConclusionsRisks 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.

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