Coiling of Middle Cerebral Artery Bifurcation Aneurysms : Clinical and Angiographic Outcomes

Objective : The anatomy of middle cerebral artery (MCA) bifurcation aneurysms has been noted to be unfavorable for endovascular treatment. Our purpose was to analyze the clinical and angiographic results of coiling of the MCA bifurcation aneurysms. Methods : From January 2004 to April 2007, 26 patients harboring 29 MCA bifurcation aneurysms were treated with coils. Of these patients, 16 had subarachnoid hemorrhages (SAH). The bleeding source was a ruptured MCA bifurcation aneurysm in 11 patients and a ruptured aneurysm in a different location in 5 patients, respectively. Treatment-related complications, clinical outcomes, and postprocedural and follow-up angiography results were retrospectively evaluated. Results : 29 MCA bifurcation aneurysms (11 ruptured, 18 unruptured) were occluded with coils in 26 patients. Occlusion was complete for 24 (82.8%) of the 29 aneurysms, incomplete for 3 (10.3%), and partial for 2 (6.9%) aneurysms. Procedural complications included thromboembolism in 6, a small nonocclusive thrombus formation in 1, and intraprocedural aneurysmal rupture in 1. All of symptomatic complications were thromboembolic events that occurred 3 patients with unruptured aneurysm and they discharged with moderate disability state. Follow-up angiograms were available on 16 patients with 18 aneurysms and 1 patient with an initial complete occlusion had a slight neck recanalization. Conclusion : Coiling of MCA bifurcation aneurysm could be achieved without treatment-induced neurologic deficit in 88.5% (23/26) of the patients while at the same time obtaining favorable anatomic results. Improvements in device technology and technique will certainly greatly increase the safety of coiling of MCA bifurcation aneurysm, widening its indications.