Abstract
The optimal strategy for the treatment of M1segment aneurysms has not yet been determined as both standard microneurosurgical and endovascular techniques can pose challenges. We sought to determine the efficacy of flow diverting stents to treat small, unruptured aneurysms of the M1segment. We retrospectively reviewed our database of prospectively collected information for all patients treated with flow diversion for an unruptured saccular aneurysm of the middle cerebral artery (MCA) between February 2009 and February 2016. The relationship to early cortical branches, aneurysm fundus size, number and type of flow diverting stent (FDS), complications and follow-up data were recorded. In total 15patients were identified that matched our inclusion criteria (11female and 4male). The average age of the patients was 58.3years (range 14-76years). All patients had asingle aneurysm affecting the M1segment of the MCA, 10 (66.6%) of which were related to early cortical branches and 10 aneurysms were located on the left (66.6%). The average aneurysm fundus size was 3 mm (range 2-9 mm) and 13 patients had follow-up angiographic studies. In total, 8aneurysms were completely excluded, and 6 remained incompletely occluded (3 modified Raymond-Roy classification [mRRC]II and 3 mRRCIIIa). One patient suffered astroke and another patient had an iatrogenic vessel dissection that was not flow limiting. Flow diversion can be used to treat small, unruptured aneurysms of the M1segment of the MCA and even though side vessel occlusion can occur clinically relevant infarction occurs infrequently.
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