Endoluminal flow diverting stents for middle cerebral artery bifurcation aneurysms: multicenter cohort
Division of Interventional Neuroradiology, Department of Radiology
Analytical, Diagnostic and Therapeutic Techniques and Equipment | Cardiovascular Diseases | Nervous System Diseases | Neurology | Neurosurgery | Radiology | Surgery
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. permissions.
aneurysm, flow diverter, stroke
DOI of Published Version
Salem MM, Khorasanizadeh M, Lay SV, Renieri L, Kuhn AL, Sweid A, Massari F, Moore JM, Tjoumakaris SI, Jabbour P, Puri AS, Ogilvy CS, Jankowitz BT, Burkhardt JK, Kan P, Limbucci N, Cognard C, Thomas AJ. Endoluminal flow diverting stents for middle cerebral artery bifurcation aneurysms: multicenter cohort. J Neurointerv Surg. 2021 Nov 3:neurintsurg-2021-018224. doi: 10.1136/neurintsurg-2021-018224. Epub ahead of print. PMID: 34732531. Link to article on publisher's site
Journal of neurointerventional surgery
Salem MM, Kuhn AL, Massari F, Puri AS, Thomas AJ. (2021). Endoluminal flow diverting stents for middle cerebral artery bifurcation aneurysms: multicenter cohort. Radiology Publications. https://doi.org/10.1136/neurintsurg-2021-018224. Retrieved from https://escholarship.umassmed.edu/radiology_pubs/658