Endovascular Treatment of Middle Cerebral Artery Aneurysm: Single Center Case Series (P05.251)

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Objective: To report feasibilty, safety and efficacy of endovascular embolization for middle cerebral artery (MCA) aneurysms. Background Middle cerebral artery (MCA) aneurysms can be treated by both craniotomy and endovascular coil embolization. However, given the complex aneurysm neck anatomy and location; it was felt that surgical approach may be more suitable. We report a feasibility, safety and efficacy of MCA aneurysms treated with endovascular embolization as our primary treatment modality. Design/Methods:We retrospectively reviewed the Neurointerventional database from July 2005 through October 2011, identifying patients who underwent endovascular embolization for MCA aneurysms with detachable coils. Data was collected on demographics, periprocedural complications and follow up imaging. Peri-procedural complications were reported as intra operative perforation (IOP), thromboembolic event (TEE), both were considered symptomatic if patient develop new neurological deficit lasting for ≥24 hours with increase in NIHSS of ≥2 compare to baseline not contributing to other etiology. Results:Total of 161/850(19%) patients underwent endovascular embolization for MCA aneurysms with average age of 55, 108(76%) were females, 105(73%) were Caucasians. There were 53(33%) patients presented with subarachnoid hemorrhage (SAH) with an average aneurysm maximum dome size of 6.74 ±3.24 and neck size of 3.6±1.85. Fifty four (34%) underwent stent assisted coil embolization, 14(9%) balloon assist coil embolization and 14(9%) required Y stent configuration. We had 100% success in treating all the aneurysms with IOP rate of 8(5%), and TEE rate of 23(14%) from which 3(2%) were symptomatic in each group. There were total of 138(86%) aneurysms who had follow up angiogram from which 20(12%) required retreatment for aneurysm recanalization. Conclusions: We report a case series of MCA aneurysm treated with EAE with 100% success rate with significant peri-procedural complication rate of 4%. We conclude that endovascular embolization can be performed safely and effectively for MCA aneurysms. Disclosure: Dr. Pandya has nothing to disclose. Dr. Lazzaro has nothing to disclose. Dr. Fitzsimmons has nothing to disclose. Dr. Lynch has nothing to disclose. Dr. Zaidat has received personal compensation for activities with Boston Scientific Corporation and Micrus Inc.