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The Aneurysm Casebook pp 1–13Cite as

Middle Cerebral Artery Bifurcation Aneurysm: Unruptured Wide-Necked Aneurysm of the Middle Cerebral Artery Bifurcation, Treatment with Intra-saccular Flow Disruptor (pCANVAS) Neck-Bridging Device, Technical Aspects and Follow-Up Results

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Abstract

A 75-year-old female patient who presented with left arm paresthesia was found to have a wide-necked aneurysm arising from the left middle cerebral artery (MCA) bifurcation. The aneurysm was treated with the pCANVAS neck-bridging device (phenox) with good clinical and angiographic outcomes. Currently the management of unruptured intracranial aneurysms is a controversial topic among the vascular neurosurgical community, with cumulative evidence supporting the effectiveness of both microsurgical and endovascular treatment options. Several endovascular strategies are available, such as balloon- and stent-assisted coiling, Y- and X-stenting, and the “waffle-cone technique,” with inconclusive rates of successful occlusion and complications. Recently, dedicated endovascular devices designed to deal with aneurysms in this difficult anatomical location have been developed, including novel neck-bridging devices, such as the pCANVAS. This device addresses the endo-saccular flow diversion concept, with the publication of a recent case series from our institution showing promising short- and medium-term results. In this chapter, we present a case demonstrating the feasibility of the pCANVAS device in the treatment of wide-necked unruptured bifurcation aneurysms. The current literature concerning the therapeutic options in the management of wide-necked bifurcation aneurysms is the main topic of this chapter.

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References

  • Aguilar-Salinas P, Brasiliense LBC, Walter CM, Hanel RA, Dumont TM. Current status of the PulseRider in the treatment of bifurcation aneurysms: a systematic review. World Neurosurg. 2018;115:288–94. https://doi.org/10.1016/j.wneu.2018.04.102.

    Article  PubMed  Google Scholar 

  • Alreshidi M, Cote DJ, Dasenbrock HH, Acosta M, Can A, Doucette J, Simjian T, Hulou MM, Wheeler LA, Huang K, Zaidi HA, Du R, Aziz-Sultan MA, Mekary RA, Smith TR. Coiling versus microsurgical clipping in the treatment of unruptured middle cerebral artery aneurysms: a meta-analysis. Neurosurgery. 2018;83(5):879–89. https://doi.org/10.1093/neuros/nyx623.

    Article  PubMed  Google Scholar 

  • Bhogal P, AlMatter M, Bäzner H, Ganslandt O, Henkes H, Aguilar Pérez M. Flow diversion for the treatment of MCA bifurcation aneurysms – a single centre experience. Front Neurol. 2017;8:20. https://doi.org/10.3389/fneur.2017.00020.

    Article  PubMed  PubMed Central  Google Scholar 

  • Chiu AH, De Vries J, O’Kelly CJ, Riina H, McDougall I, Tippett J, Wan M, de Oliveira Manoel AL, Marotta TR. The second-generation eCLIPs endovascular clip system: initial experience. J Neurosurg. 2018;128(2):482–9. https://doi.org/10.3171/2016.10.JNS161731.

    Article  PubMed  Google Scholar 

  • Gory B, Rouchaud A, Saleme S, Dalmay F, Riva R, Caire F, Mounayer C. Endovascular treatment of middle cerebral artery aneurysms for 120 nonselected patients: a prospective cohort study. AJNR Am J Neuroradiol. 2014;35(4):715–20. https://doi.org/10.3174/ajnr.A3781.

    Article  CAS  PubMed  Google Scholar 

  • Gory B, Aguilar-Pérez M, Pomero E, Turjman F, Weber W, Fischer S, Henkes H, Biondi A. One-year angiographic results after pCONus stent-assisted coiling of 40 wide-neck middle cerebral artery aneurysms. Neurosurgery. 2017;80(6):925–33. https://doi.org/10.1093/neuros/nyw131.

    Article  PubMed  Google Scholar 

  • Greving JP, Wermer MJ, Brown RD Jr, Morita A, Juvela S, Yonekura M, Ishibashi T, Torner JC, Nakayama T, Rinkel GJ, Algra A. Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: a pooled analysis of six prospective cohort studies. Lancet Neurol. 2014;13(1):59–66. https://doi.org/10.1016/S1474-4422(13)70263-1.

    Article  PubMed  Google Scholar 

  • Iosif C, Mounayer C, Yavuz K, Saleme S, Geyik S, Cekirge HS, Saatci I. Middle cerebral artery bifurcation aneurysms treated by extrasaccular flow diverters: midterm angiographic evolution and clinical outcome. AJNR Am J Neuroradiol. 2017;38(2):310–6. https://doi.org/10.3174/ajnr.A5022.

    Article  CAS  PubMed  Google Scholar 

  • Kassell NF, Torner JC, Haley EC Jr, Jane JA, Adams HP, Kongable GL. The international cooperative study on the timing of aneurysm surgery. Part 1: overall management results. J Neurosurg. 1990;73(1):18–36.

    Article  CAS  Google Scholar 

  • Kotowski M, Naggara O, Darsaut TE, Nolet S, Gevry G, Kouznetsov E, Raymond J. Safety and occlusion rates of surgical treatment of unruptured intracranial aneurysms: a systematic review and meta-analysis of the literature from 1990 to 2011. J Neurol Neurosurg Psychiatry. 2013;84(1):42–8. https://doi.org/10.1136/jnnp-2011-302068.

    Article  PubMed  Google Scholar 

  • Lin N, Ho A, Gross BA, Pieper S, Frerichs KU, Day AL, Du R. Differences in simple morphological variables in ruptured and unruptured middle cerebral artery aneurysms. J Neurosurg. 2012;117(5):913–9. https://doi.org/10.3171/2012.7.JNS111766.

    Article  PubMed  Google Scholar 

  • Lylyk P, Chudyk J, Bleise C, Sahl H, Pérez MA, Henkes H, Bhogal P. The pCONus2 neck-bridging device: early clinical experience and immediate angiographic results. World Neurosurg. 2018a;110:e766–75. https://doi.org/10.1016/j.wneu.2017.11.097.

    Article  PubMed  Google Scholar 

  • Lylyk P, Chudyk J, Bleise C, Henkes H, Bhogal P. Treatment of wide-necked bifurcation aneurysms: initial results with the pCANvas neck bridging device. Clin Neuroradiol. 2018b; https://doi.org/10.1007/s00062-018-0680-6.

    Article  Google Scholar 

  • Mukherjee S, Chandran A, Gopinathan A, Putharan M, Goddard T, Eldridge PR, Patankar T, Nahser HC. PulseRider-assisted treatment of wide-necked intracranial bifurcation aneurysms: safety and feasibility study. J Neurosurg. 2017;127(1):61–8. https://doi.org/10.3171/2016.2.JNS152334.

    Article  PubMed  Google Scholar 

  • Naggara ON, White PM, Guilbert F, Roy D, Weill A, Raymond J. Endovascular treatment of intracranial unruptured aneurysms: systematic review and meta-analysis of the literature on safety and efficacy. Radiology. 2010;256(3):887–97. https://doi.org/10.1148/radiol.10091982.

    Article  PubMed  Google Scholar 

  • Pérez MA, Henkes H, Bouillot P, Brina O, Slater LA, Pereira VM. Intra-aneurysmal hemodynamics: evaluation of pCONus and pCANvas bifurcation aneurysm devices using DSA optical flow imaging. J Neurointerv Surg. 2016;8(11):1197–201. https://doi.org/10.1136/neurintsurg-2015-011927.

    Article  PubMed  Google Scholar 

  • Pierot L, Klisch J, Cognard C, Szikora I, Mine B, Kadziolka K, Sychra V, Gubucz I, Januel AC, Lubicz B. Endovascular WEB flow disruption in middle cerebral artery aneurysms: preliminary feasibility, clinical, and anatomical results in a multicenter study. Neurosurgery. 2013;73(1):27–34.; discussion 34–5. https://doi.org/10.1227/01.neu.0000429860.04276.c1.

    Article  PubMed  Google Scholar 

  • Saleme S, Iosif C, Ponomarjova S, Mendes G, Camilleri Y, Caire F, Boncoeur MP, Mounayer C. Flow-diverting stents for intracranial bifurcation aneurysm treatment. Neurosurgery. 2014;75(6):623–31;. quiz 631. https://doi.org/10.1227/NEU.0000000000000522.

    Article  PubMed  Google Scholar 

  • Smith TR, Cote DJ, Dasenbrock HH, Hamade YJ, Zammar SG, El Tecle NE, Batjer HH, Bendok BR. Comparison of the efficacy and safety of endovascular coiling versus microsurgical clipping for unruptured middle cerebral artery aneurysms: a systematic review and meta-analysis. World Neurosurg. 2015;84(4):942–53. https://doi.org/10.1016/j.wneu.2015.05.073.

    Article  PubMed  Google Scholar 

  • Tanriover N, Kawashima M, Rhoton AL Jr, Ulm AJ, Mericle RA. Microsurgical anatomy of the early branches of the middle cerebral artery: morphometric analysis and classification with angiographic correlation. J Neurosurg. 2003;98(6):1277–90.

    Article  Google Scholar 

  • Tau N, Sadeh-Gonik U, Aulagner G, Turjman F, Gory B, Armoiry X. The Woven EndoBridge (WEB) for endovascular therapy of intracranial aneurysms: update of a systematic review with meta-analysis. Clin Neurol Neurosurg. 2018;166:110–5. https://doi.org/10.1016/j.clineuro.2018.01.025.

    Article  PubMed  Google Scholar 

  • Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, Forbes GS, Thielen K, Nichols D, O’Fallon WM, Peacock J, Jaeger L, Kassell NF, Kongable-Beckman GL, Torner JC, International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362(9378):103–10.

    Article  Google Scholar 

  • Yavuz K, Geyik S, Saatci I, Cekirge HS. Endovascular treatment of middle cerebral artery aneurysms with flow modification with the use of the pipeline embolization device. AJNR Am J Neuroradiol. 2014;35(3):529–35. https://doi.org/10.3174/ajnr.A3692.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Clinica La Sagrada Familia, ENERI, Buenos Aires, Argentina

    Pablo Albiña, Rene Viso, Ivan Lylyk, Rodolfo Nella Castro & Pedro Lylyk

Authors
  1. Pablo Albiña
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  2. Rene Viso
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  3. Ivan Lylyk
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  4. Rodolfo Nella Castro
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  5. Pedro Lylyk
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Correspondence to Pedro Lylyk .

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Editors and Affiliations

  1. Department of Neuroradiology, Klinikum Stuttgart, Stuttgart, Baden-Württemberg, Germany

    Hans Henkes

  2. Dept. Neurosurgery & Intervent. Neurorad, Clinica Sagrada Familia , Buenos Aires, Argentina

    Pedro Lylyk

  3. Department of Neurosurgery, Klinikum Stuttgart Department of Neurosurgery, Stuttgart, Baden-Württemberg, Germany

    Oliver Ganslandt

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Albiña, P., Viso, R., Lylyk, I., Castro, R.N., Lylyk, P. (2019). Middle Cerebral Artery Bifurcation Aneurysm: Unruptured Wide-Necked Aneurysm of the Middle Cerebral Artery Bifurcation, Treatment with Intra-saccular Flow Disruptor (pCANVAS) Neck-Bridging Device, Technical Aspects and Follow-Up Results. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Aneurysm Casebook. Springer, Cham. https://doi.org/10.1007/978-3-319-70267-4_120-1

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  • DOI: https://doi.org/10.1007/978-3-319-70267-4_120-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-70267-4

  • Online ISBN: 978-3-319-70267-4

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