Coil embolization of the middle cerebral artery bifurcation aneurysms: efficacy, safety, and durability

Abstract

ABSTRACT

Coil embolization of the middle cerebral artery bifurcation aneurysms: efficacy, safety, and durability

Hyoung Soo Byoun Department of Neurosurgery College of Medicine The Graduate School of Hanyang University

Purpose A paradigm is shifting in the treatment of cerebral aneurysms due to the development of endovascular technology and devices. Endovascular coil embolization is increasingly preferred over conventional surgical clipping through open craniotomy. However, surgical clipping is still preferred to treat the middle cerebral artery (MCA) aneurysm, especially the middle cerebral artery bifurcation (MCAB) aneurysm, which has favorable surgical accessibility. Our purpose is to evaluate the efficacy, safety, and durability of coil embolization for MCAB aneurysm by analyzing clinical and radiological results.

Methods From January 2008 to June 2018, we treated total of 1785 aneurysms using coil embolization. Among them, 223 MCAB aneurysms analyzed retrospectively. Clinical and radiological assessments were performed at admission, after treatment, at discharge, and at last clinical follow-up. Results Coil embolization was performed on 223 MCAB aneurysms in 217 patients. Peri-procedural ischemic, hemorrhagic, and other complications within 30 days after coil embolization were 8.0%, 8.0%, and 2.0%, respectively, in ruptured group, and 2.9%, 1.2%, and 0%, respectively, in unruptured group. The overall morbidity and mortality associated with complications were 2.3% and 2.0%. Initial complete occlusion rates were 70.0% for ruptured group and 52.6% for unruptured group. Incomplete, but satisfactory occlusion rates were 100% for ruptured group and 89.0% for unruptured group. The cumulative major recurrence rates were 5.1% at 12 months, 7.1% at 18 months, and 11.9% at 3 years after coil embolization. Mean follow-up period was 33.27 ± 25.48 months. Independent risk factors for major recurrence after coil embolization of MCAB aneurysm were ruptured aneurysm, initial incomplete occlusion, aneurysm size, and neck size.

Conclusion Coil embolization is a good alternative treatment option for MCAB aneurysm compared with surgical clipping. Considering the risk factors for major recurrence, the follow-up angiography should be continued until 3 years after coil embolization.