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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleNeurointervention
Open Access

Middle Cerebral Artery Bifurcation Aneurysms Treated by Extrasaccular Flow Diverters: Midterm Angiographic Evolution and Clinical Outcome

C. Iosif, C. Mounayer, K. Yavuz, S. Saleme, S. Geyik, H.S. Cekirge and I. Saatci
American Journal of Neuroradiology February 2017, 38 (2) 310-316; DOI: https://doi.org/10.3174/ajnr.A5022
C. Iosif
aFrom the Interventional Neuroradiology Department (C.I., C.M., S.S.), Dupuytren University Hospital (Centre Hospitalier Universitaire Limoges), Limoges, France
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  • ORCID record for C. Iosif
C. Mounayer
aFrom the Interventional Neuroradiology Department (C.I., C.M., S.S.), Dupuytren University Hospital (Centre Hospitalier Universitaire Limoges), Limoges, France
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K. Yavuz
bInterventional Neuroradiology Department (K.Y.), Ankara University, School of Medicine, Ankara, Turkey
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S. Saleme
aFrom the Interventional Neuroradiology Department (C.I., C.M., S.S.), Dupuytren University Hospital (Centre Hospitalier Universitaire Limoges), Limoges, France
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S. Geyik
cInterventional Neuroradiology Department (S.G.), Memorial HealthCare Group, Istanbul, Turkey
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H.S. Cekirge
eInterventional Neuroradiology Department (H.S.C.), Koru Hospital and Bayındır Hospital, Ankara, Turkey.
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I. Saatci
dInterventional Neuroradiology Department (I.S.), Yuksek Ihtisas University, Koru Hospital, Ankara, Turkey
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Article Figures & Data

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  • Fig 1.
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    Fig 1.

    Pretreatment 3D image (A) shows a multilobulated right MCA aneurysm with a bleb. Note that the superior trunk originates from the sac. Control DSA 1 year after Pipeline Embolization Device placement. An image at a corresponding angle (B) demonstrates total occlusion of the aneurysm with the branch coming off the patent sac (Cekirge-Saatci class 1a occlusion).

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    Fig 2.

    Pretreatment 3D (A) and 2D (B) images show a small, irregular right MCA aneurysm with an early bifurcating branch (arrow) originating from the sac. Corresponding DSA obtained 1 year after PED treatment (C) confirms the total occlusion of the aneurysm; the branch coming off the sac (arrow) is reduced in caliber (Cekirge-Saatci class 1b occlusion).

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    Fig 3.

    Pretreatment 3D image (A) shows a left MCA aneurysm with the inferior trunk coming off the sac. Posttreatment 1- (B) and 2-year (C) angiograms confirm the stable occlusion of the sac with the patent inferior trunk (arrow) having a tortuous origin (Cekirge-Saatci class 5 occlusion).

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    Fig 4.

    Pretreatment 2D (A) and 3D (B) images show an irregular right MCA aneurysm with a bleb. Note that the aneurysm has no neck, and a branch is originating from the sac. Six-month control DSA image at a corresponding angle (C) reveals the sac decreased in size, but still filling (class 2). Correlative 1-year control DSA image demonstrates total occlusion of the aneurysm sac with the relevant branch filling retrogradely (white arrow) (ie, Cekirge-Saatci class 1c occlusion).

Tables

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    Table 1:

    Modifications of the mRS throughout the follow-up period

    PRE txDischarge mRS (n = 58)6-Month mRS (n = 58)≥12-Month mRS (n = 58)
    mRSNo. of Patients01230123012
    01212000120001200
    1410371a2a26114a1a3093
    250411a3100a310
    Total5812412341124145103
    • Note:—PRE tx indicates pretreatment values.

    • ↵a Number of patients with clinical worsening in regard to pretreatment clinical status.

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    Table 2:

    Immediate postprocedure angiographic results and angiographic outcomes in controls

    Cekirge-Saatci Evaluation ScaleImmediate Angiographic Outcome≥12-Month Angiographic OutcomeThird (Midterm) Angiographic Outcome
    1a3 (4.8%)18 (28.6%)16 (40.0%)
    1b014 (22.2%)10 (25.0%)
    1c013 (20.6%)8 (20.0%)
    202 (3.2%)0
    31 (1.6%)1 (1.6%)1 (2.5%)
    4a30 (47.6%)00
    4b29 (46%)00
    5015 (23.8%)5 (12.5%)
    Total63 (100%)63 (100%)40 (100%)
    χ2, 48.175; df, 3χ2, 24.524; df, 5χ2,15.750; df, 4
    Significance level, P < .0001Significance level, P = .0002Significance level, P = .0034
    • View popup
    Table 3:

    Angiographic outcomes regarding jailed branches

    Jailed Branch Fate6-Month Follow-Up12-Month Follow-Up3rd (Midterm) Follow-Up
    Asymptomatic narrowing1828.6%1015.9%512.5%
    Symptomatic narrowing000000
    Asymptomatic occlusion914.3%0012.5%
    Symptomatic occlusion23.2%0000
    Better opacification or “reopening”0057.9%00
    No change3454.0%4876.2%3485.0%
    Total63100.0%63100%40100%
    χ2, 36.365; df, 3χ2, 52.667; df, 2χ2, 48.650; df, 2
    Significance level, P < .0001Significance level, P < .0001Significance level, P < .0001
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American Journal of Neuroradiology: 38 (2)
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Cite this article
C. Iosif, C. Mounayer, K. Yavuz, S. Saleme, S. Geyik, H.S. Cekirge, I. Saatci
Middle Cerebral Artery Bifurcation Aneurysms Treated by Extrasaccular Flow Diverters: Midterm Angiographic Evolution and Clinical Outcome
American Journal of Neuroradiology Feb 2017, 38 (2) 310-316; DOI: 10.3174/ajnr.A5022

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Middle Cerebral Artery Bifurcation Aneurysms Treated by Extrasaccular Flow Diverters: Midterm Angiographic Evolution and Clinical Outcome
C. Iosif, C. Mounayer, K. Yavuz, S. Saleme, S. Geyik, H.S. Cekirge, I. Saatci
American Journal of Neuroradiology Feb 2017, 38 (2) 310-316; DOI: 10.3174/ajnr.A5022
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