414 Flow Diversion for Middle Cerebral Artery Bifurcation Aneurysms: A Multicenter Cohort. (1st April 2022)

• Record Type: Journal Article
• Authors: Salem, Mohamed M.; Dmytriw, Adam A.; Khorasanizadeh, MirHojjat; Lay, Sovann Vathana; Renieri, Leonardo; Sweid, Ahmad; Moore, Justin M.; Jabbour, Pascal; Ogilvy, Christopher S.; Limbucci, Nicola; Cognard, Christophe; Thomas, Ajith J.
• Is Part Of: Neurosurgery. Volume 68(2022)Supplement 1
• Page Start: 96
• Page End: 96
• Publication Date: 2022-04-01
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/NEU.0000000000001880_414
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract : INTRODUCTION: Data regarding safety and efficacy of flow diversion in treatment of middle cerebral artery (MCA) bifurcations 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: We retrospectively reviewed prospectively-maintained databases for patients harboring MCA bifurcation aneurysms who underwent flow diversion treatment in 4 US and European centers in the period from 2011-2018. The relevant clinical and radiographic data was collected from the medical records. The primary outcome was aneurysm occlusion at the last follow up with secondary outcomes of clinical status and complications. RESULTS: Sixty-two patients (median age 57.1 years, 66% females) harboring 62 aneurysms were included. Majority of aneurysms were unruptured (79%); 74.2% were saccular and with a mean maximal diameter of 9 mm. Last imaging follow-up was performed at a median of 16.3 months after the treatment, showing complete occlusion in 61.3%, and near complete occlusion (90-99%) in 17.7% of aneurysms. The overall rate of ischemic and hemorrhagic complications were 11.3% and 1.6% respectively. Symptomatic and permanent complications were encountered in 4.8% and 3.2% of patients respectively. Retreatment was pursued in 3.2% of the patients. Jailed branch occlusion was detected in 12.9% of cases. Last follow up mRS of 0-2 was noted in 96.8% of patients. CONCLUSION: Flow diversion for MCA bifurcation aneurysms is feasible with reasonable safety and efficacy profile when utilized in carefully selected aneurysms. Jailing of M2 branches is not associated with a high risk of post-procedural ischemic complications.