Endovascular treatment of complex MCA aneurysms
EANS Academy. Kiselev V. 09/25/19; 275629; EP01008
Vitaly Kiselev
Vitaly Kiselev

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Introduction: Endovascular therapy of intracranial aneurysms is rapidly undergoing major developments. With increasing experience and development of appropriate devices the indications for endovascular aneurysm therapy have considerably widened.The middle cerebral artery (MCA) is a very common site for aneurysm formation. MCA aneurysms represent 18% to 40% of all intracranial aneurysms. Although MCA aneurysms are easily accessed in the surgical clipping approach, MCA bifurcation location is often considered for endovascular treatment.
Materials and methods: For the period from 05.2014 to 12.2018 inclusive, in the department of vascular neurosurgery, endovascular operations on MCA aneurysms were performed in 23 patients. The mean age was 50,2 years. Men were 10 (43%), women - 13 (57%). Most aneurysms were located at M1 segment 10 (43,5%). 8 (34,8%) of the aneurysms were at MCA bifurcation and 5 (21,7%) at distal part of the artery. Saccular aneurysms were 19 (82,7%), fusiform - 4 (17,3%).Immediate and 6-months angiographic results were evaluated by Raymond-Roy Scale. To assess clinical outcome, we applied modified Rankin scale (mRs)..
Results: A total 23 endovascular procedures were performed. Coiling we used in 1 (4,4%) patients, coiling with stent-assistance - 14 (60,9%) or with balloon-assistance - 3 (13%) and in 5 (21,7%) cases we deployed flow-diverters (FD). Following types of stenting techniques were used: single stent was used in 4 (28,6%) cases, Y-stenting in 8 (57,1%) patients and telescopic stenting - 2 (14,3%) case. Immediate complete occlusion rate (Raymond I) was achieved in 16 (88,8%), near complete (Raymond II) in 2 (11,2%) aneurysms. We excluded FD from the immediate result evaluation. Complications leading to permanent morbidity in 1 patient (4,3%). Good clinical result (mRs 0-2) has been got in 22 (95,7%).
Conclusion: Endovascular treatment of MCA aneurysms is effective and can be performed with acceptable morbidity in selected patients.
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