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Endovascular Treatment of Middle Cerebral Artery Aneurysms with Electrolytically Detachable Coils

A. Doerfler*,a, I. Wanke*,a, S.L. Goerickea, H. Wiedemayera, T. Engelhorna, E.R. Gizewskia, D. Stolkeb and M. Forstinga

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


Figure 1
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  		Fig 1. A, Left internal carotid artery (ICA) angiogram showing a left middle cerebral artery (MCA) bifurcation aneurysm and an additional distal MCA aneurysm.

B and C, Left ICA angiogram after complete embolization of both MCA aneurysms.

D, Left ICA angiogram 4 days after coil embolization demonstrating severe vasospasms at the distal ICA and proximal MCA.

E, After successful balloon dilation of the ICA and proximal MCA by using a 3-mm balloon occlusion system.

F and G, Six-month follow-up showing partial recanalization of both aneurysms as a result of coil compaction (arrowhead at distal MCA aneurysm).

H and I, Left ICA angiogram after retreatment showing complete occlusion of both MCA aneurysms (arrowhead at distal MCA aneurysm).


Figure 2
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  		Fig 2. Case 1.

A, Left internal carotid artery (ICA) angiogram showing a 3-mm left middle cerebral artery (MCA) bifurcation aneurysm.

B, Left ICA angiogram after complete aneurysm occlusion with 2 coils (GDC-10: 3 x 6, 2 x 4). Note the occlusion of the small neighboring arterial branch M2 (arrowhead).

C, Left ICA angiogram, lateral view, late arterial phase after selective intra-arterial thrombolysis (1 Mio IU urokinase) still showing a small perfusion deficit. The MCA was partially filled in a retrograde manner through cortical vessels, thus avoiding larger infarction. Outcome according GOS at 6 months was GR.


Figure 3
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  		Fig 3. Case 2.

A, Right internal carotid artery (ICA) angiogram, oblique view, showing a 4-mm aneurysm at the right middle cerebral artery (MCA) bifurcation.

B, Right ICA angiogram, oblique view, after embolization with 3 platinum coils (GDC-10: 4 x 10, 3 x 8, 2 x 4) still demonstrating a slight opacification of the medial aneurysm rim, classified as subtotal occlusion.

C, Follow-up angiogram 6 months after embolization revealed subsequent thrombosis with total (100%) aneurysm occlusion.


Figure 4
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  		Fig 4. Case 3.

A, CT angiography revealing bilateral asymptomatic middle cerebral artery (MCA) bifurcation aneurysms and an additional aneurysm at the left distal superior cerebellar artery.

B and C, In a first procedure, the left MCA and the cerebellar superior artery aneurysms were completely embolized.

D–F, Eight weeks later, the right MCA bifurcation aneurysm was completely occluded with coils.





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X