Endovascular Treatment of Middle Cerebral Artery Aneurysms as First Option: A Single Center Experience of 92 Aneurysms

R.S. Quadros; S. Gallas; R. Noudel; P. Rousseaux; L. Pierot

doi:10.3174/ajnr.A0595

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Fig 1.
Raymond classification for aneurysmal occlusions. (Reproduced with permission from Roy D, Milot G, Raymond J. Endovascular treatment of unruptured aneurysms. Stroke 2001;32:1998–2004.)
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Fig 2.
Flow chart of options for treatment of MCAAs.
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Fig 3.
Distribution of 59 MCAAs initially proposed for EVT. ACA indicates anterior cerebral artery.
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Fig 4.
Diameter of 59 MCAAs initially proposed for EVT.
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Fig 5.
Flow chart of occlusion rates for 55 aneurysms treated by endovascular coiling. * indicates patients who died or were lost to follow-up; §, surgically treated patients.

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Table 1:

Patient characteristics, clinical data, aneurysm size, and outcome of 55 patients with middle central artery aneurysms treated by endovascular coiling

Patient No./Sex/Age	SAH/MCAA	HH	Side	Size, mm	Initial Occlusion Rate	EVT Complication	GOS at 1 Month	Follow-up, mo	Retreatment	Final Occlusion Rate	Rankin^†
1/F/68	x	3	R	6	Residual neck		GR	42		Residual neck	0
2/F/49	x	5	R	6	Complete		SD	42		Residual neck	1
3/M/74	x	2	R	8	Complete		MD	41		Complete	1
4/F/37		0	R/L	6/4	Residual necks		GR	42		Residual necks	0
5/M/29	x	4	L	16	Complete		D	0			6
6/F/34	x	3	L	13	Residual aneurysm		D	0			6
7/M/24	x	2	R	4	Complete		D	0			6
8/F/52		0	R	7,5	Complete	Thromb echn	GR	30		Residual neck	0
9/M/35	x	2	R	9	Residual neck		GR	24		Residual neck	0
10/F/42	x	4	R	5	Complete		D	0			6
11/M/48		0	L	9	Complete		GR	12		Complete	0
12/F/48	x	2	L	5	Residual aneurysm		MD	24		Residual neck	0
13/F/72		0	R	6	Complete		GR	12		Residual neck	0
14/M/44	x	4	R	15	Complete	Thromboemb	D	0			6
15/F/53		0	R	6	Complete		GR	25		Residual neck	0
16/F/71	x	4	R	8		Failure	SD	6	Not treated		5
17/F/59	x	3	R	12	Residual aneurysm		SD	6		^*	5
18/F/47	x	4	L	9	Residual neck	Rupture	MD	27		Residual neck	3
19/M/42	x	2	L	5	Complete		GR	24		Residual neck	0
20/F/47	x	2	R	6,5	Complete		GR	24		Complete	0
21/F/43		2	R	7,6	Complete		MD	12		Residual neck	3
22/F/52		0	R	6,5	Residual neck		GR	24		Complete	0
23/F/34		0	R	6	Residual neck		MD	12		Residual neck	2
24/F/38		0	R	2,4	Complete		GR	12		Complete	0
25/F/25	x	2	L	8	Complete		GR	12	Re-embolized	Complete	0
26/F/51		0	R	5	Complete		GR	16		Complete	0
27/M/33		0	L	9		Failure	GR	10	Re-embolized at another hospital		1
28/F/34	x	2	L	6.5	Residual neck		GR	12		Residual neck	0
29/M/50	x	3	L	8	Complete	Thromboemb	MD	12		Complete	2
30/M/51		3	R	12	Residual neck		MD	11		Residual neck	3
31/F/45	x	3	L	4		Failure	MD	1		^*	3
32/F/50		0	R	15	Residual aneurysm		GR	12		Residual neck	0
33/M/55	x	2	R	8	Residual neck		MD	10		^*	2
34/F/36	x	3	R	7		Failure	GR		Surgery		3
35/F/49	x	2	L	4,5	Residual neck		GR	11		Residual neck	0
36/F/68	x	5	L	12	Complete		D	0			6
37/F/39	x	2	L	8	Complete	Thromboemb	MD	12		Complete	1
38/F/44	x	2	R	7	Complete		GR	11		Residual neck	0
39/F/53		0	L/R/R	20/5/8	Residual aneurysm/residual necks		GR	12		Residual necks	0
40/M/66	x	1	R	5	Residual neck		MD	12		Residual neck	3
41/F/44		0	L	6	Residual neck	Thromboemb	SD	12		Complete	2
42/F/54		2	L	6	Residual aneurysm		SD	1			6
43/F/60	x	2	L	10	Residual neck	Thromboemb	MD	10		Complete	2
44/F/54	x	2	L	9	Residual aneurysm		GR	9	To be retreated	Residual aneurysm	1
45/M/49		0	R	6	Residual neck	Thromboemb	GR	9		Residual neck	0
46/F/32		0	R	4	Residual neck		GR	6		Residual neck	0
47/M/47	x	2	L	8	Residual neck		GR	1		^*	0
48/M/55	x	1	L	10	Residual aneurysm	Thromboemb	MD	6	Surgery		2
49/M/54		0	R/L	9/7	Residual necks	Thromboemb R	MD	4		R residual aneurysm/L residual neck	1
50/F/41		0	R	8	Residual neck		GR	3		Complete	0
51/F/43	x	3	L	12	Residual neck	Rupture	MD	5		Residual neck	1
52/F/50		0	R	9	Complete	Thromboemb	SD	4		Complete	4
53/F/67		0	R	5	Complete		GR	3		Complete	0
54/F/52	x	5	R	9,6	Residual neck		MD	1		^*	3
55/F/69	x	2	R	8	Complete	Rupture	SD	1		^*	4

Note:—SAH/MCAA indicates subarachnoid hemorrhage from middle cerebral artery aneurysm; M, male; F, female; HH, Hunt and Hess grading scale; EVT, endovascular treatment; GOS, Glasgow outcome scale; R, right side, L, left side; Thromboemb, thromboembolism; Thromb echn, thromboembolism and technical complication. For GOS scores: GR indicates good recovery; MD, moderately disabled; SD, severely disabled; D, died.
* Data are not available.
† Modified Rankin scale is the last control.

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Table 2:

Patient characteristics, clinical data, and outcome at discharge for patients with middle cerebral artery aneurysms not treated by coiling as first option

No./Sex/Age, y	HH	SAH/MCA	Surgery	Treatment Reason	Rankin^*
1/M/63	4	x	x	Wide neck + branch	6
2/M/29	2	x	x	Microaneurysm + hematoma	4
3/F/54	4		x	Wide neck + branch	1
4/M/36	5	x		Severe clinical condition	6
5/M/59	3	x	x	Wide neck + branch	3
6/M/51	4	x	x	Voluminous hematoma	6
7/M/45	0		x	Wide neck + branch	0
8/M/40	0		x	Wide neck + branch	0
9/M/43	0			Unruptured microaneurysm	1
10/F/42	0			Unruptured microaneurysm	0
11/M/72	4	x	x	Wide neck + branch	5
12/M/52	2	x	x	Voluminous hematoma	3
13/M/50	0			Calcified aneurysm	1
14/F/39	0			2 unruptured microaneurysms	0
15/F/76	2	x		Severe clinical condition	6
16/F/38	1	x	x	Microaneurysm + hematoma	6
17/M/51	1	x	x	Microaneurysm + hematoma	1
18/M/57	4			Unruptured microaneurysm	3
19/F/33	3	x	x	Wide neck + branch	3
20/F/53	2	x	x	CRI	1
21/F/42	0			Thrombosed aneurysm	1
22/F/37	0			CRI	2
23/F/45	5	x		Severe clinical condition	6
24/F/55	4	x	x	Voluminous hematoma	6
25/F/45	3	x	x	Microaneurysm + hematoma	4
26/F/71	2			Unruptured microaneurysm	0
27/F/49	0			Wide neck + branch	0
28/F/59	5	x	x	Wide neck + branch	1
29/F/44	2	x	x	Wide neck + branch	3
30/M/54	0			Unruptured microaneurysm	1
31/M/41	0		x	Wide neck + branch	2
32/M/39	0			Unruptured microaneurysm	0

Note:—HH indicates Hunt and Hess grading scale; SAH/MCA, subarachnoid hemorrhage from middle cerebral artery aneurysm; CRI, chronic renal insufficiency; F, female; M, male.
* Modified Rankin scale at discharge.