Endovascular treatment of middle cerebral artery aneurysms: A systematic review and single-center series

Waleed Brinjikji, Giuseppe Lanzino, Harry J. Cloft, Alejandro Rabinstein, David F Kallmes

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

BACKGROUND: Middle cerebral artery (MCA) aneurysms are often considered unsuitable for endovascular coiling because of unfavorable morphological features. With improvements in endovascular techniques, several series have detailed the results and complications of endovascular treatment of MCA aneurysms. OBJECTIVE: We performed a systematic review of published series on endovascular treatment of MCA aneurysms including our experience. METHODS: We conducted a computerized MEDLINE search of the literature on endovascular treatment of MCA aneurysms. Only studies examining a consecutive case series of MCA aneurysms were included. We then extracted information regarding intraprocedural complications, procedural mortality and morbidity, immediate and long-term angiographic outcomes, and re-treatment rate. Analysis was done including 40 MCA aneurysms treated at our institution. RESULTS: Twelve studies including our institution's consecutive case series were included. Approximately 50% of the aneurysms presented as ruptured. Intraprocedural rupture rate in unruptured aneurysms was 1.7% (95% confidence interval [CI] = 0.7%- 3.6%) compared with 4.8% (95% CI = 3.1%-7.4%) for ruptured aneurysms (P = 02). The risk of early postprocedural hemorrhage was 1.1% (95% CI = 0.5%-2.5%) for ruptured aneurysms. Overall procedure-related permanent morbidity and mortality were 5.1% and 6.0% for unruptured and ruptured aneurysms, respectively. The overall rate of complete or near-complete obliteration at angiographic follow-up was 82.4%. CONCLUSION: Endovascular treatment of MCA aneurysms is feasible and effective in selected cases. The combined periprocedural mortality and morbidity is not negligible (5.1%) and the overall rate of complete or near-complete angiographic obliteration at follow-up approaches 82%.

Original languageEnglish (US)
Pages (from-to)397-402
Number of pages6
JournalNeurosurgery
Volume68
Issue number2
DOIs
StatePublished - Feb 2011

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Intracranial Aneurysm
Ruptured Aneurysm
Confidence Intervals
Morbidity
Aneurysm
Mortality
Endovascular Procedures
MEDLINE
Rupture
Hemorrhage

Keywords

  • Cerebral aneurysm
  • Endovascular coiling
  • Systematic review

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Endovascular treatment of middle cerebral artery aneurysms : A systematic review and single-center series. / Brinjikji, Waleed; Lanzino, Giuseppe; Cloft, Harry J.; Rabinstein, Alejandro; Kallmes, David F.

In: Neurosurgery, Vol. 68, No. 2, 02.2011, p. 397-402.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Middle cerebral artery (MCA) aneurysms are often considered unsuitable for endovascular coiling because of unfavorable morphological features. With improvements in endovascular techniques, several series have detailed the results and complications of endovascular treatment of MCA aneurysms. OBJECTIVE: We performed a systematic review of published series on endovascular treatment of MCA aneurysms including our experience. METHODS: We conducted a computerized MEDLINE search of the literature on endovascular treatment of MCA aneurysms. Only studies examining a consecutive case series of MCA aneurysms were included. We then extracted information regarding intraprocedural complications, procedural mortality and morbidity, immediate and long-term angiographic outcomes, and re-treatment rate. Analysis was done including 40 MCA aneurysms treated at our institution. RESULTS: Twelve studies including our institution's consecutive case series were included. Approximately 50{\%} of the aneurysms presented as ruptured. Intraprocedural rupture rate in unruptured aneurysms was 1.7{\%} (95{\%} confidence interval [CI] = 0.7{\%}- 3.6{\%}) compared with 4.8{\%} (95{\%} CI = 3.1{\%}-7.4{\%}) for ruptured aneurysms (P = 02). The risk of early postprocedural hemorrhage was 1.1{\%} (95{\%} CI = 0.5{\%}-2.5{\%}) for ruptured aneurysms. Overall procedure-related permanent morbidity and mortality were 5.1{\%} and 6.0{\%} for unruptured and ruptured aneurysms, respectively. The overall rate of complete or near-complete obliteration at angiographic follow-up was 82.4{\%}. CONCLUSION: Endovascular treatment of MCA aneurysms is feasible and effective in selected cases. The combined periprocedural mortality and morbidity is not negligible (5.1{\%}) and the overall rate of complete or near-complete angiographic obliteration at follow-up approaches 82{\%}.",
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N2 - BACKGROUND: Middle cerebral artery (MCA) aneurysms are often considered unsuitable for endovascular coiling because of unfavorable morphological features. With improvements in endovascular techniques, several series have detailed the results and complications of endovascular treatment of MCA aneurysms. OBJECTIVE: We performed a systematic review of published series on endovascular treatment of MCA aneurysms including our experience. METHODS: We conducted a computerized MEDLINE search of the literature on endovascular treatment of MCA aneurysms. Only studies examining a consecutive case series of MCA aneurysms were included. We then extracted information regarding intraprocedural complications, procedural mortality and morbidity, immediate and long-term angiographic outcomes, and re-treatment rate. Analysis was done including 40 MCA aneurysms treated at our institution. RESULTS: Twelve studies including our institution's consecutive case series were included. Approximately 50% of the aneurysms presented as ruptured. Intraprocedural rupture rate in unruptured aneurysms was 1.7% (95% confidence interval [CI] = 0.7%- 3.6%) compared with 4.8% (95% CI = 3.1%-7.4%) for ruptured aneurysms (P = 02). The risk of early postprocedural hemorrhage was 1.1% (95% CI = 0.5%-2.5%) for ruptured aneurysms. Overall procedure-related permanent morbidity and mortality were 5.1% and 6.0% for unruptured and ruptured aneurysms, respectively. The overall rate of complete or near-complete obliteration at angiographic follow-up was 82.4%. CONCLUSION: Endovascular treatment of MCA aneurysms is feasible and effective in selected cases. The combined periprocedural mortality and morbidity is not negligible (5.1%) and the overall rate of complete or near-complete angiographic obliteration at follow-up approaches 82%.

AB - BACKGROUND: Middle cerebral artery (MCA) aneurysms are often considered unsuitable for endovascular coiling because of unfavorable morphological features. With improvements in endovascular techniques, several series have detailed the results and complications of endovascular treatment of MCA aneurysms. OBJECTIVE: We performed a systematic review of published series on endovascular treatment of MCA aneurysms including our experience. METHODS: We conducted a computerized MEDLINE search of the literature on endovascular treatment of MCA aneurysms. Only studies examining a consecutive case series of MCA aneurysms were included. We then extracted information regarding intraprocedural complications, procedural mortality and morbidity, immediate and long-term angiographic outcomes, and re-treatment rate. Analysis was done including 40 MCA aneurysms treated at our institution. RESULTS: Twelve studies including our institution's consecutive case series were included. Approximately 50% of the aneurysms presented as ruptured. Intraprocedural rupture rate in unruptured aneurysms was 1.7% (95% confidence interval [CI] = 0.7%- 3.6%) compared with 4.8% (95% CI = 3.1%-7.4%) for ruptured aneurysms (P = 02). The risk of early postprocedural hemorrhage was 1.1% (95% CI = 0.5%-2.5%) for ruptured aneurysms. Overall procedure-related permanent morbidity and mortality were 5.1% and 6.0% for unruptured and ruptured aneurysms, respectively. The overall rate of complete or near-complete obliteration at angiographic follow-up was 82.4%. CONCLUSION: Endovascular treatment of MCA aneurysms is feasible and effective in selected cases. The combined periprocedural mortality and morbidity is not negligible (5.1%) and the overall rate of complete or near-complete angiographic obliteration at follow-up approaches 82%.

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