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.
Key Words
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Article info
Publication history
Published online: April 28, 2014
Accepted:
December 4,
2013
Received in revised form:
November 14,
2013
Received:
August 27,
2013
Footnotes
This work was supported by the National Natural Science Foundation of China (81000494), the Dawn Project of Shanghai (11CG043), and the Science and Technology Commission of Shanghai Municipality (10441901902).
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.12.054
Copyright
© 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.
