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Endovascular Treatment of Ruptured Middle Cerebral Artery Bifurcation Aneurysms. A Retrospective Observational Study of Short- and Long-Term Follow-Up

  • Clinical Investigation
  • Stroke/Neurointerventions
  • Published:
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Abstract

Purpose

With the introduction of new devices and the development of approved devices, endovascular techniques are more and more considered as a treatment option for middle cerebral artery aneurysms (MCA). In this study, we present data on ruptured MCA aneurysms that were treated endovascularly in our hospital.

Material and Methods

In a retrospective case series of ruptured MCA bifurcation aneurysms, 118 (94%) cases were managed endovascularly between May 2008 and July 2017. Most were managed with coiling (= 62) and the remaining were managed with stent-assisted-coiling (= 35) and endovascular flow disruptor (WEB-device) (= 21). We measured the clinical outcome at the time of discharge and long-term follow-up on the modified Rankin Scale (mRS) and evaluated the rates of periprocedural complications and retreatment.

Results

A good clinical outcome (mRS 0–2) at discharge was achieved in 58.5% of these cases. Mortality rate was 19.5%. Nine aneurysms required retreatment. Eighty-three percent demonstrated a good clinical outcome at long-term follow-up (mRS 0–2). In total, 6 (5.1%) procedure-related complications and 10 (8.5%) disease-related complications occurred. No significant difference between reintervention, complications or outcome was found between the employment of different devices (P > 0.05). Endovascular treatment of ruptured MCA aneurysms at our practice showed similar morbidity and mortality to data published about surgical clipping.

Conclusion

The endovascular device evolution permits a feasible and safe treatment of ruptured MCA bifurcation aneurysms. Endovascular treatment can therefore be considered as an alternative treatment option to microsurgery for this type of aneurysm.

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Abbreviations

WEB-Device:

Woven-endo-bridge device

RROC:

Raymond-Roy classification

mRS:

Modified Rankin Scale

H&H:

Hunt and Hess Scale

SAC:

Stent-assisted-coiling

BAC:

Balloon-assisted coiling

ICH:

Intracerebral hemorrhage

SAH:

Subarachnoid hemorrhage

EVT:

Endovascular treatment

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Acknowledgements

A sincere thanks to Bassel Almarie, MD and Diane Wolff, for their diligent editing and proofreading of this article.

Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Neuroradiology, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany

    Florian Hagen, Ansgar Berlis & Christoph Johannes Maurer

  2. Department of Diagnostic and Interventional Neuroradiology, Universitätsklinikum Magdeburg, Leipzigerstraße 44, 39120, Magdeburg, Germany

    Martin Skalej

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  1. Florian Hagen
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Correspondence to Florian Hagen.

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Conflict of interest

F. Hagen has no conflict of interest. A. Berlis is proctor for Sequent Medical, Microvention, Stryker and Medtronic and received lecture royalities for Penumbra. Fee for CEC from Phenox. M. Skalej has no conflict of interest. CJ. Maurer received an educational grant from Microvention and Stryker.

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Hagen, F., Berlis, A., Skalej, M. et al. Endovascular Treatment of Ruptured Middle Cerebral Artery Bifurcation Aneurysms. A Retrospective Observational Study of Short- and Long-Term Follow-Up. Cardiovasc Intervent Radiol 44, 587–595 (2021). https://doi.org/10.1007/s00270-020-02718-9

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