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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 27:513-520, March 2006
© 2006 American Society of Neuroradiology

INTERVENTIONAL

Endovascular Treatment of Middle Cerebral Artery Aneurysms with Electrolytically Detachable Coils

A. Doerfler^*,a, I. Wanke^*,a, S.L. Goericke^a, H. Wiedemayer^a, T. Engelhorn^a, E.R. Gizewski^a, D. Stolke^b and M. Forsting^a

^a Department of Neuroradiology University of Essen Medical School, Essen, Germany
^b Department of Neurosurgery, University of Essen Medical School, Essen, Germany

Address correspondence to Arnd Doerfler, MD, Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054 Erlangen, Germany

BACKGROUND AND PURPOSE: Middle cerebral artery (MCA) aneurysms often have an unfavorable aneurysm geometry that might limit endovascular therapy. Our purpose was to analyze the feasibility, safety, and efficacy of coil embolization in a consecutive series of MCA aneurysms chosen for endovascular treatment.

PATIENTS AND TECHNIQUES: Of 235 MCA aneurysms seen at our institution during the past 5 years, 36 patients harboring 38 MCA aneurysms were primarily selected for coil embolization: 18 patients had an acute subarachnoid hemorrhage (SAH), 16 of which were due to a ruptured MCA aneurysm. SAH was classified according to Hunt and Hess grade: I (5), II (7), III (5), IV (0), and V (1).

RESULTS: Complete occlusion could be achieved in 33 of 38 aneurysms. In 5 aneurysms, coil embolization was not performed because of an unfavorable aneurysm geometry with a wide neck or incorporation of adjacent branches (3) or failed because of insecure coil placement (1) or severe vasospasm (1). Procedural complications included coil protrusion into the parent artery (1), and thromboembolic M2 occlusion (5), with recanalization in 4 of 5 cases. Of 8 aneurysms with initial subtotal occlusion, 3 progressed to total occlusion during follow-up. Three aneurysms had to be retreated, and no patient rebled. Glasgow Outcome Scale at 6 months for the patients with SAH (17/18) was good recovery (12), moderate disability (4), severe disability (0), persistent vegetative state (0), and death (1); outcomes for patients with an incidental aneurysm (17/18) were good recovery (16) and moderate disability (1).

CONCLUSION: Endovascular coil embolization can be performed safely and effectively in selected MCA aneurysms. Initial subtotal aneurysm occlusion might progress to total occlusion.

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