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Research ArticleNeurointervention

Endovascular Treatment of Unruptured MCA Bifurcation Aneurysms Regardless of Aneurysm Morphology: Short- and Long-Term Follow-Up

F. Hagen, C.J. Maurer and A. Berlis
American Journal of Neuroradiology March 2019, 40 (3) 503-509; DOI: https://doi.org/10.3174/ajnr.A5977
F. Hagen
aFrom the Department of Diagnostic and Interventional Neuroradiology, Klinikum Augsburg, Augsburg, Germany.
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C.J. Maurer
aFrom the Department of Diagnostic and Interventional Neuroradiology, Klinikum Augsburg, Augsburg, Germany.
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A. Berlis
aFrom the Department of Diagnostic and Interventional Neuroradiology, Klinikum Augsburg, Augsburg, Germany.
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    Fig 1.

    Study design.

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    Fig 2.

    Total intervention time by technique.

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    Fig 3.

    Retreatment rate of aneurysms treated with the WEB device (2013–2017).

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    Table 1:

    Demographic data

    Coil GroupWEB Group (n = 38)Significance
    Coiling (n = 45)Stent-Assisted Coiling (n = 67)
    Age (mean) (yr)54.6 ± 10.555.7 ± 10.859.8 ± 11.7.071a
    Sex (No.)
        Male12 (26.7%)17 (25.4%)13 (34.2%).638b
        Female33 (73.3%)50 (74.6%)25 (65.8%)
    Hypertension (No.)24 (53.3%)38 (65.7%)25 (65.8%).497b
    Diabetes (No.)1 (2.2%)7 (10.4%)2 (5.3%).254b
    Smoker (No.)16 (35.6%)30 (44.8%)17 (44.3%).611b
    • ↵a Kruskal-Wallis H test.

    • ↵b Fisher exact test.

    • View popup
    Table 2:

    Aneurysm characteristics

    Coil GroupWEB Group (n = 38)Significance
    Coiling (n = 45)Stent-Assisted Coiling (n = 67)
    Aneurysm size (No.)
        0–7 mm37 (82.2%)47 (70.1%)19 (50.0%).014a
        8–15 mm7 (15.6%)16 (23.9%)19 (50.0%)
        16–25 mm1 (2.2%)4 (6.0%)0 (0.0%)
        >25 mm0 (0.0%)0 (0.0%)0 (0.0%)
    Aneurysm neck (mean) (mm)2.9 ± 1.03.9 ± 1.54.46 ± 1.26.000b
    Aspect ratio (dome/neck) (mean)3.29 ± 1.482.60 ± 0.982.55 ± 1.00.005b
    Side (No.)
        Right20 (44.4%)36 (53.7%)27 (71.1%).050b
        Left25 (55.6%)31 (46.3%)11 (28.9%)
    Partially thrombosed (No.)2 (4.4%)2 (3.0%)3 (7.8%)1.000c
    • ↵a χ2 linear by linear.

    • ↵b Kruskal-Wallis H test.

    • ↵c Fisher exact test.

    • View popup
    Table 3:

    Procedural and related complications

    Coil GroupWEB Group (n = 38)Significance
    Coiling (n = 45)Stent-Assisted Coiling (n = 67)
    Procedural time (mean) (min)155.5 ± 68.2165.1 ± 54.3136.3 ± 55.8.018a
    Total device per aneurysm implanted (mean)3.8 ± 2.47.3 ± 5.81.0 ± 0.0.000a
    Complication rate (No.) according to Table 43 (6.7%)5 (7.4%)3 (7.9%)1.000b
    • ↵a Kruskal-Wallis H test.

    • ↵b Fisher exact test.

    • View popup
    Table 4:

    Complications and outcome

    Patient No.ComplicationHospitalization Time (days)mRS at DischargemRS Long-Term/monthsAntiaggregation
    WEB group
        65Ischemia due to local thrombus800/12Simple
        92Occlusion of external iliac artery903/48Simple
        121Ischemia due to local thrombus221/6Simple
    Coil group
        Coiling
            6Aneurysm rupture1700/36Simple
            37Ischemia due to local thrombus1132/12Double
            179Ischemia due to local thrombus401/3Simple
    Stent-assisted coiling
            36Ischemia due to local thrombus1132/12Double
            45Aneurysm rupture246–Double
            99Infarction without thrombus detection843/12Double
            116Ischemia due to local thrombus844/36Double
            158Relevant vasospasm830/12Double
    • View popup
    Table 5:

    Follow-up and reintervention rate

    Coil GroupWEB Group (n = 38)Significance
    Coiling (n = 45)Stent-Assisted Coiling (n = 67)
    Follow-up-period (mean) (mo)38.9 ± 26.829.9 ± 23.422.3 ± 16.7.024a
    Rate of retreatment (No.)1 (2.2%)4 (5.9%)8 (21.1%).014b
    Delay of retreatment after procedure (mean) (mo)12 ± 0.09.8 ± 9.64.5 ± 1.6.187a
    mRS (discharge) (mean)0.3 ± 0.80.6 ± 1.40.2 ± 0.6.283a
    Good clinical outcome at discharge (mRS ≤ 2) (No.)42 (93.3%)58 (86.6%)37 (97.4%).186b
    Death (No.)0101.000b
    Clinical outcome (No.)
        mRS at last follow-up (No.)
            033 (84.6%)38 (73.1%)32 (88,9%)
            13 (7.7%)2 (3.9%)2 (5.6%)
            21 (2.6%)3 (5.8%)0 (0.0%).164b
            3–51 (2.6%)6 (11.5%)2 (5.6%)
            61 (2.6%)3 (5.8%)0 (0.0%)
    Follow-up period (No.)
        mRS improvement or consistent34 (87.2%)40 (77.0%)33 (91.6%)
        mRS degradation5 (12.8%)12 (23.0%)3 (8.3%).109b
    • ↵a Kruskal-Wallis H test.

    • ↵b Fisher exact test.

    • View popup
    Table 6:

    Characteristics of retreated aneurysms

    Coil GroupWEB Group (n = 8)Significance
    Coiling (n = 1)Stent-Assisted Coiling (n = 4)
    Aneurysm size (No.)
        0–7 mm1 (100%)1 (25%)2 (25.0%).734a
        8–15 mm0 (0.0%)2 (50%)6 (75.0%)
        16–25 mm0 (0.0%)1 (25%)0 (0.0%)
        >25 mm0 (0.0%)0 (0.0%)0 (0.0%)
    Side (No.)
        Right1 (100%)4 (100%)3 (37,5%).046b
        Left0 (0%)0 (0%)5 (62,5%)
    Aneurysm neck (mean) (mm)1.68 ± 0.05.03 ± 1.495.38 ± 1.14.273c
    Aspect ratio (dome/neck) (mean)4.17 ± 0.03.25 ± 2.012.45 ± 0.71.406c
    • ↵a χ2 linear by linear.

    • ↵b Fisher exact test.

    • ↵c Kruskal-Wallis H test.

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American Journal of Neuroradiology: 40 (3)
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Cite this article
F. Hagen, C.J. Maurer, A. Berlis
Endovascular Treatment of Unruptured MCA Bifurcation Aneurysms Regardless of Aneurysm Morphology: Short- and Long-Term Follow-Up
American Journal of Neuroradiology Mar 2019, 40 (3) 503-509; DOI: 10.3174/ajnr.A5977

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Endovascular Treatment of Unruptured MCA Bifurcation Aneurysms Regardless of Aneurysm Morphology: Short- and Long-Term Follow-Up
F. Hagen, C.J. Maurer, A. Berlis
American Journal of Neuroradiology Mar 2019, 40 (3) 503-509; DOI: 10.3174/ajnr.A5977
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