Flow Diversion for Middle Cerebral Artery Aneurysms: An International Cohort Study

Jose Danilo Bengzon Diestro, Nimer Adeeb, Mahmoud Dibas, William Boisseau, Pablo Harker, Waleed Brinjikji, Sishi Xiang, Evan Joyce, Maksim Shapiro, Eytan Raz, Carmen Parra-Farinas, Gwynedd Pickett, Naif M. Alotaibi, Robert W. Regenhardt, Joshua D. Bernstock, Julian Spears, Christoph J. Griessenauer, Jan Karl Burkhardt, Muhammad U. Hafeez, Peter KanRamesh Grandhi, Philipp Taussky, Erez Nossek, Tao Hong, Hongqi Zhang, Lorenzo Rinaldo, Giuseppe Lanzino, Christopher J. Stapleton, James D. Rabinov, Aman B. Patel, Thomas R. Marotta, Daniel Roy, Adam A. Dmytriw

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Open surgery has traditionally been preferred for the management of bifurcation middle cerebral artery (MCA) aneurysms. Flow diverting stents present a novel endovascular strategy for aneurysm treatment. OBJECTIVE: To add to the limited literature describing the outcomes and complications in the use of flow diverters for the treatment of these complex aneurysms. METHODS: This is a multicenter retrospective review of MCA bifurcation aneurysms undergoing flow diversion. We assessed post-treatment radiological outcomes and both thromboembolic and hemorrhagic complications. RESULTS: We reviewed the outcomes of 54 aneurysms treated with flow diversion. Four (7.4%) of the aneurysms had a history of rupture (3 remote and 1 acute). Fourteen (25.9%) of the aneurysms already underwent either open surgery or coiling prior to flow diversion. A total of 36 out of the 45 aneurysms (80%) with available follow-up data had adequate aneurysm occlusion with a median follow-up time of 12 mo. There were no hemorrhagic complications but 16.7% (9/54) had thromboembolic complications. CONCLUSION: Flow diverting stents may be a viable option for the endovascular treatment of complex bifurcation MCA aneurysms. However, compared to published series on the open surgical treatment of this subset of aneurysms, flow diversion has inferior outcomes and are associated with a higher rate of complications.

Original languageEnglish (US)
Pages (from-to)1112-1121
Number of pages10
JournalNeurosurgery
Volume89
Issue number6
DOIs
StatePublished - Nov 18 2021

Keywords

  • Endovascular
  • Flow diversion
  • Intracranial aneurysm
  • Middle cerebral artery
  • Pipeline

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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