Osman Melih Topcuoglu1, Erol Akgul2, Ergun Daglioglu3, Elif Dilara Topcuoglu4, Ahmet Peker5, Ilkay Akmangit6, Deniz Belen3, Anil Arat7. 1. Department of Radiology, Kecioren Education and Research Hospital, Ankara, Turkey. 2. Department of Radiology, Cukurova University Medical School, Adana, Turkey. 3. Department of Neurosurgery, Numune Education and Research Hospital, Ankara, Turkey. 4. Department of Radiology, Ufuk University Medical School, Ankara, Turkey. 5. Department of Radiology, Hacettepe University Medical School, Ankara, Turkey. 6. Department of Radiology, Numune Education and Research Hospital, Ankara, Turkey. 7. Department of Radiology, Numune Education and Research Hospital, Ankara, Turkey; Department of Radiology, Hacettepe University Medical School, Ankara, Turkey. Electronic address: anilarat@hotmail.com.
Abstract
BACKGROUND AND OBJECTIVE: The outcome of flow diversion for middle cerebral artery (MCA) aneurysms, one of the most common sites for intracranial aneurysms, has not been defined thoroughly. We assessed our outcomes in MCA aneurysms (MCAAs) treated by flow diversion, i.e., with either dedicated flow diverters or telescopic stents. METHODS: Patients with MCAAs were treated by flow diversion if surgical or other endovascular treatment modalities had failed or were deemed likely to fail. Angiographic and clinical outcome of these patients was assessed retrospectively. Aneurysm location on MCA was defined as M1 segment, "true bifurcation" (classical bifurcation of MCA into superior and inferior trunks), "variant bifurcation" (bifurcation of early frontal or early/distal temporal branches), or M2 segment. Aneurysm morphology was classified as saccular versus dissecting/fusiform. RESULTS: Treatment was attempted in 29 MCAAs. Technical failure rate was 3.4% (1/29). Thirteen of aneurysms were fusiform. Of the bifurcation aneurysms, most (10/16) were the variant type. Overall and procedure-related mortality/permanent morbidity rates were 10.3% (3/29) and 3.5% (1/29). Total occlusion rates (mean angiographic follow-up 10.3 months) for saccular and fusiform aneurysms were 40% and 75%, respectively. In bifurcation aneurysms, occlusion was strongly associated with side-branch occlusion (P < 0.005). CONCLUSIONS: In this series, flow diversion for the treatment of MCAAs was safe, was effective in the treatment of fusiform MCAAs, and was not as effective at mid-term for MCA bifurcation aneurysms. Unsatisfactory occlusion rate in bifurcation aneurysms likely results from residual filling of the aneurysms in cases in which the jailed side branch remains patent.
BACKGROUND AND OBJECTIVE: The outcome of flow diversion for middle cerebral artery (MCA) aneurysms, one of the most common sites for intracranial aneurysms, has not been defined thoroughly. We assessed our outcomes in MCA aneurysms (MCAAs) treated by flow diversion, i.e., with either dedicated flow diverters or telescopic stents. METHODS:Patients with MCAAs were treated by flow diversion if surgical or other endovascular treatment modalities had failed or were deemed likely to fail. Angiographic and clinical outcome of these patients was assessed retrospectively. Aneurysm location on MCA was defined as M1 segment, "true bifurcation" (classical bifurcation of MCA into superior and inferior trunks), "variant bifurcation" (bifurcation of early frontal or early/distal temporal branches), or M2 segment. Aneurysm morphology was classified as saccular versus dissecting/fusiform. RESULTS: Treatment was attempted in 29 MCAAs. Technical failure rate was 3.4% (1/29). Thirteen of aneurysms were fusiform. Of the bifurcation aneurysms, most (10/16) were the variant type. Overall and procedure-related mortality/permanent morbidity rates were 10.3% (3/29) and 3.5% (1/29). Total occlusion rates (mean angiographic follow-up 10.3 months) for saccular and fusiform aneurysms were 40% and 75%, respectively. In bifurcation aneurysms, occlusion was strongly associated with side-branch occlusion (P < 0.005). CONCLUSIONS: In this series, flow diversion for the treatment of MCAAs was safe, was effective in the treatment of fusiform MCAAs, and was not as effective at mid-term for MCA bifurcation aneurysms. Unsatisfactory occlusion rate in bifurcation aneurysms likely results from residual filling of the aneurysms in cases in which the jailed side branch remains patent.
Authors: F Cagnazzo; P-H Lefevre; I Derraz; C Dargazanli; G Gascou; D T di Carlo; P Perrini; R Ahmed; J F Hak; C Riquelme; A Bonafe; V Costalat Journal: AJNR Am J Neuroradiol Date: 2020-01 Impact factor: 3.825
Authors: Anna Luisa Kühn; Peter Kan; Nils Henninger; Visish Srinivasan; Katyucia de Macedo Rodrigues; Ajay K Wakhloo; Matthew J Gounis; Ajit S Puri Journal: J Clin Neurosci Date: 2019-05-06 Impact factor: 1.961
Authors: F Cagnazzo; P Perrini; C Dargazanli; P-H Lefevre; G Gascou; R Morganti; D di Carlo; I Derraz; C Riquelme; A Bonafe; V Costalat Journal: AJNR Am J Neuroradiol Date: 2019-03-14 Impact factor: 3.825