Yeungnam Univ J Med.  2019 Sep;36(3):208-218. 10.12701/yujm.2019.00192.

Feasibility and efficacy of coil embolization for middle cerebral artery aneurysms

• Choi JY
• Choi CH
• Ko JK
• Lee JI
• Huh CW
• Lee TH

• KMID: 2460189
• DOI: http://doi.org/10.12701/yujm.2019.00192

Abstract

BACKGROUND
The anatomy of middle cerebral artery (MCA) aneurysms has been noted to be unfavorable for endovascular treatment. The purpose of this study was to assess the feasibility and efficacy of coiling for MCA aneurysms.
METHODS
From January 2004 to December 2015, 72 MCA aneurysms (38 unruptured and 34 ruptured) in 67 patients were treated with coils. Treatment-related complications, clinical outcomes, and immediate and follow-up angiographic outcomes were retrospectively analyzed.
RESULTS
Aneurysms were located at the MCA bifurcation (n=60), 1st segment (M1, n=8), and 2nd segment (M2, n=4). Sixty-nine aneurysms (95.8%) were treated by neck remodeling techniques using multi-catheter (n=44), balloon (n=14), stent (n=8), or combination of these (n=3). Only 3 aneurysms were treated by single-catheter technique. Angiographic results were 66 (91.7%) complete, 5 (6.9%) remnant neck, and 1 (1.4%) incomplete occlusion. Procedural complications included aneurysm rupture (n=1), asymptomatic coil migration to the distal vessel (n=1), and acute thromboembolism (n=10) consisting of 8 asymptomatic and 2 symptomatic events. Treatment-related permanent morbidity and mortality rates were 4.5% and 3.0%, respectively. There was no bleeding on clinical follow-up (mean, 29 months; range, 6-108 months). Follow-up angiographic results (mean, 26 months; range, 6-96 months) in patients included 1 major and 3 minor recanalizations.
CONCLUSION
Coiling of MCA aneurysms could be a technically feasible and clinically effective treatment strategy with acceptable angiographic and clinical outcomes. However, the safety and efficacy of this technique as compared to surgical clipping remains to be ascertained.

Keyword

Coil embolization; Intracranial aneurysm; Middle cerebral artery

MeSH Terms

Aneurysm
Embolization, Therapeutic*
Follow-Up Studies
Hemorrhage
Humans
Intracranial Aneurysm*
Middle Cerebral Artery*
Mortality
Neck
Retrospective Studies
Rupture
Stents
Surgical Instruments
Thromboembolism

Figure

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  Fig. 1. A 43-year-old man presented with a subarachnoid hemorrhage. (A) Anteroposterior oblique view of left internal carotid angiogram shows a wide-necked aneurysm (arrow) at the right middle cerebral artery bifurcation. (B) The aneurysm is treated with two catheter technique (arrowheads). (C) Final control angiogram reveals complete occlusion of the aneurysm (arrow) without flow compromise of the parent artery. (D) Eighteen-month follow-up angiogram shows stable, complete occlusion of the aneurysm (arrow).

• 

  Fig. 2. A 73-year-old woman with a ruptured aneurysm at the left middle cerebral artery bifurcation. (A) Anteroposterior oblique view of left internal carotid angiogram shows an elongated aneurysm (arrows). (B) The aneurysm is treated with balloon-assisted technique (arrow) due to coil protrusion into the parent artery at coil insertion into the neck portion. Immediate post-procedural radiograph (C) and angiogram (D) reveal complete occlusion of the aneurysm (arrow) without coil protrusion into parent artery. Follow-up 18-month angiogram (E) and 41-month magnetic resonance angiogram (F) show stable, complete occlusion of the aneurysm (arrow).

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  Fig. 3. A 52-year-old man presented with severe headache. (A) Non-enhanced brain computed tomography reveals subarachnoid hemorrhage at the left Sylvian fissure. (B) Anteroposterior oblique view of left internal carotid angiogram shows a wide-necked aneurysm (arrow) at the left middle cerebral artery bifurcation and moderate to severe vasospasm of the anterior and middle cerebral arteries (arrowheads). (C) Prior to coil embolization, angioplasty using a compliant balloon (arrow) is performed to resolve vasospasm. The aneurysm is treated with a stent-assisted technique (arrows) and immediate post-procedural radiograph (D) and angiogram (E) reveal complete occlusion of the aneurysm (arrow) and restoration of vasospasm (arrowheads). (F) A 6-month follow-up angiogram after the procedure demonstrates stable complete occlusion of the aneurysm (arrow) and well-preserved parent artery.

Reference

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