Stent placement for complex middle cerebral artery aneurysms.

Abstract

BACKGROUND:

To evaluate the safety and effectiveness of stent placement for ruptured or unruptured middle cerebral artery (MCA) aneurysms in a larger number.

METHODS:

Between October 2003 and December 2012, data for 70 patients with 72 complex MCA aneurysms treated with stents at our institution were retrospectively collected and analyzed.

RESULTS:

Eighty-five stents were successfully deployed in this series. However, failure of followed coiling was encountered in 2 (2.8%) tiny aneurysms of them. Of the 63 aneurysms treated with stent-assisted coiling, complete occlusion was achieved in 22 (34.9%), neck remnant in 15 (23.8%), and residual sac in 26 (36.5%). Of the 9 aneurysms treated with stent alone, the results were contrast stasis in 3 aneurysms and no change in 6. Procedure-related complications occurred in 9 (12.5%) procedures, including 7 of 27 (25.9%) with ruptured aneurysms and 2 of 45 (4.4%) with unruptured aneurysms, which resulted in 1 death and 5 disabilities. Univariate and multivariate analyses show that ruptured aneurysm is an independent factor for the outcome of these patients (odds ratio, 7.35; 95% confidence interval, 1.35-40.0). Angiographic follow-up results (mean, 10.5±8.8 months) showed that 72.1% (44 of 61) were completely occluded, 4.9% (3 of 61) recurred, and others were stable or had improved. Intrastent stenosis was observed in 1 (1.6%) patient, which was managed conservatively. During a clinical follow-up period ranging from 7 to 113 months (mean, 33.0±22.4 months), 1 disabled patient died from severe pneumonia, whereas the clinical status of the others had improved or was stable. Procedure-related morbidity/mortality during the follow-up for the ruptured and unruptured groups were 3.7%/3.7% and 0/0, respectively.

CONCLUSIONS:

Our study shows that stent placement for the treatment of certain wide-neck MCA aneurysms is feasible, safe, and effective. However, stent placement for acutely ruptured MCA aneurysms harbors a much higher complication rate.

• Authors: Yu Zhou, Peng-Fei Yang, Qiang Li, Rui Zhao, Yi-Bin Fang, Yi Xu, Bo Hong, Wen-Yuan Zhao, Qing-Hai Huang, Jian-Min Liu
• Journal: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association (J Stroke Cerebrovasc Dis) Vol. 23 Issue 6 Pg. 1447-56 (Jul 2014) ISSN: 1532-8511 [Electronic] United States
• PMID: 24774440 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Chemical References

• Anticoagulants
• Platelet Aggregation Inhibitors
• Clopidogrel
• Ticlopidine
• Aspirin

Topics

• Adult
• Aged
• Aneurysm, Ruptured (diagnostic imaging, drug therapy, surgery)
• Anticoagulants (therapeutic use)
• Aspirin (therapeutic use)
• Cerebral Angiography
• Clopidogrel
• Female
• Humans
• Intracranial Aneurysm (diagnostic imaging, drug therapy, surgery)
• Male
• Middle Aged
• Platelet Aggregation Inhibitors (therapeutic use)
• Retrospective Studies
• Stents
• Ticlopidine (analogs & derivatives, therapeutic use)
• Treatment Failure
• Treatment Outcome