Provocative tests and parent artery occlusion in the endovascular treatment of distal middle cerebral artery pseudoaneurysms.

We retrospectively analyzed the angiographic results and endovascular outcomes of 13 patients with pseudoaneurysms (PA) of the distal middle cerebral artery (dMCA). Endovascular provocative tests such as the temporary balloon occlusion test (BOT), and the super-selective intra-arterial "amytal" (amobarbital) test (IAT) were performed in these patients. Four patients underwent the BOT test and all patients underwent the IAT. The provocative tests were negative in 11 patients, after which successful parent artery occlusion (PAO) with detachable coils and onyx-18 was feasibly achieved. Immediate and 6-36 months of follow-up clinical evaluations showed a favorable outcome. Provocative tests are important in not only the selection of endovascular therapeutic methods for PA of the dMCA, but also to assist in accurately assessing patient prognosis.