Journal of Yeungnam Medical Science

Yeungnam University College of Medicine, Yeungnam University Institute Medical Science (영남대 의대 학술지 편집위원회)
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Feasibility and efficacy of coil embolization for middle cerebral artery aneurysms

  • Choi, Jae Young (Department of Neurosurgery, Kosin University Gospel Hospital) ;
  • Choi, Chang Hwa (Department of Neurosurgery, Pusan National University Hospital) ;
  • Ko, Jun Kyeung (Department of Neurosurgery, Pusan National University Hospital) ;
  • Lee, Jae Il (Department of Neurosurgery, Pusan National University Hospital) ;
  • Huh, Chae Wook (Department of Neurosurgery, Pusan National University Hospital) ;
  • Lee, Tae Hong (Department of Diagnostic Radiology, Pusan National University Hospital)
  • Received : 2019.01.09
  • Accepted : 2019.04.10
  • Published : 2019.09.30
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Abstract

Background: The anatomy of middle cerebral artery (MCA) aneurysms has been noted to be unfavorable for endovascular treatment. The purpose of this study was to assess the feasibility and efficacy of coiling for MCA aneurysms. Methods: From January 2004 to December 2015, 72 MCA aneurysms (38 unruptured and 34 ruptured) in 67 patients were treated with coils. Treatment-related complications, clinical outcomes, and immediate and follow-up angiographic outcomes were retrospectively analyzed. Results: Aneurysms were located at the MCA bifurcation (n=60), 1st segment (M1, n=8), and 2nd segment (M2, n=4). Sixty-nine aneurysms (95.8%) were treated by neck remodeling techniques using multi-catheter (n=44), balloon (n=14), stent (n=8), or combination of these (n=3). Only 3 aneurysms were treated by single-catheter technique. Angiographic results were 66 (91.7%) complete, 5 (6.9%) remnant neck, and 1 (1.4%) incomplete occlusion. Procedural complications included aneurysm rupture (n=1), asymptomatic coil migration to the distal vessel (n=1), and acute thromboembolism (n=10) consisting of 8 asymptomatic and 2 symptomatic events. Treatment-related permanent morbidity and mortality rates were 4.5% and 3.0%, respectively. There was no bleeding on clinical follow-up (mean, 29 months; range, 6-108 months). Follow-up angiographic results (mean, 26 months; range, 6-96 months) in patients included 1 major and 3 minor recanalizations. Conclusion: Coiling of MCA aneurysms could be a technically feasible and clinically effective treatment strategy with acceptable angiographic and clinical outcomes. However, the safety and efficacy of this technique as compared to surgical clipping remains to be ascertained.

Keywords

Acknowledgement

Supported by : Pusan National University

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