Endoluminal flow diverting stents for middle cerebral artery bifurcation aneurysms: multicenter cohort.
Publication/Presentation Date
11-1-2022
Abstract
BACKGROUND: Data regarding the safety and efficacy of flow diverting stents (FDS) in the treatment of middle cerebral artery (MCA) bifurcation aneurysms are scarce and limited to small single center series, with particular concern for increased risk of ischemic complications with jailing one of the M2 branches.
METHODS: Prospectively-maintained databases at six North American and European centers were queried for patients harboring MCA bifurcation aneurysms undergoing treatment with FDS (2011-2018). The pertinent clinical and radiographic data were collected and analyzed.
RESULTS: 87 patients (median age 60 years, 69% females) harboring 87 aneurysms were included. The majority of aneurysms were unruptured (79%); 75.9% were saccular with a median maximal diameter of 8.5 mm. Radiographic imaging follow-up was available in 88.5% of cases at a median of 16.3 months post-treatment, showing complete occlusion in 59% and near complete occlusion (90-99%) in 18% of aneurysms. The overall rate of ischemic and hemorrhagic complications was 8% and 1.1%, respectively. Symptomatic and permanent complications were encountered in 5.7% and 2.3% of patients respectively, with retreatment pursued in 2.3% of patients. Jailed branch occlusion was detected in 11.5% of cases, with clinical sequelae in 2.3%. Last follow-up modified Rankin Scale of 0-2 was noted in 96.8% of patients. On multivariate analysis, male sex was the only independent predictor of aneurysmal persistence at last follow-up imaging (p=0.019).
CONCLUSION: FDS treatment for MCA bifurcation aneurysms is feasible, with comparable safety and efficacy profiles to other available endovascular options when utilized in carefully selected aneurysms. Jailing of M2 branches was not associated with a higher risk of post-procedural ischemic complications.
Volume
14
Issue
11
First Page
1084
Last Page
1089
ISSN
1759-8486
Published In/Presented At
Salem, M. M., Khorasanizadeh, M., Lay, S. V., Renieri, L., Kuhn, A. L., Sweid, A., Massari, F., Moore, J. M., Tjoumakaris, S. I., Jabbour, P., Puri, A. S., Ogilvy, C. S., Jankowitz, B. T., Burkhardt, J. K., Kan, P., Limbucci, N., Cognard, C., & Thomas, A. J. (2022). Endoluminal flow diverting stents for middle cerebral artery bifurcation aneurysms: multicenter cohort. Journal of neurointerventional surgery, 14(11), 1084–1089. https://doi.org/10.1136/neurintsurg-2021-018224
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
34732531
Department(s)
Administration and Leadership
Document Type
Article