Department of Neurosurgery and Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, NY, USA.
Acta Neurochir (Wien). 2013 Apr;155(4):559-68. doi: 10.1007/s00701-012-1594-8. Epub 2013 Jan 29.
Middle cerebral artery (MCA) aneurysms are among the more challenging aneurysms for endovascular treatment. We report a contemporary 5-year experience with endovascular therapy for MCA aneurysms at a high-volume neurovascular center.
Review of prospectively maintained intracranial aneurysm database.
Between 2005 and 2009, 148 patients underwent treatment of 149 MCA aneurysms at our hospital, of which 33 patients with 34 aneurysms underwent endovascular therapy. Among these 33 patients, 14 presented with subarachnoid hemorrhage. Eleven patients were treated with stent-assisted coiling, 1 with balloon-assisted coiling, and the remainder with coiling alone. Three patients required repeat endovascular treatment. There were 7 periprocedural complications, including intraprocedural aneurysm rupture resulting in death in 2 patients. Two patients died at later dates from remote aneurysm rehemorrhage. Average follow-up of remaining patients was 17.1 months radiographically, and 20.3 months clinically. Average modified Rankin scale (mRS) score at last follow up was 2.09, with 17 patients with mRS 0/1 and 5 patients with mRS 2. Fifteen patients showed evidence of radiographic residual at last follow up: 13 were simple neck residuals. Unruptured status and saccular aneurysms were associated with mRS 0/1 outcome (each p < 0.05).
At our hospital, MCA aneurysms are being treated with endovascular techniques, but in a minority of patients. Despite the rate of residual neck remnants, few retreatments were necessary and few rehemorrhages occurred. The periprocedural complication rate was not insignificant; therefore, in more recent years and at present, most MCA aneurysms are considered for clipping first at our center.
大脑中动脉（MCA）动脉瘤是血管内治疗中更具挑战性的动脉瘤之一。我们报告了一家高容量神经血管中心在过去 5 年中对 MCA 动脉瘤进行血管内治疗的经验。
回顾性分析颅内动脉瘤数据库。
2005 年至 2009 年，我院共治疗 149 例 MCA 动脉瘤患者，其中 33 例（34 个动脉瘤）接受血管内治疗。这 33 例患者中，14 例蛛网膜下腔出血。11 例患者接受支架辅助弹簧圈治疗，1 例患者接受球囊辅助弹簧圈治疗，其余患者仅接受弹簧圈治疗。3 例患者需要重复血管内治疗。7 例围手术期并发症，包括术中动脉瘤破裂导致 2 例死亡。2 例患者后期因动脉瘤再出血死亡。其余患者平均随访 17.1 个月影像学，20.3 个月临床。末次随访时平均改良 Rankin 量表（mRS）评分为 2.09，17 例 mRS 0/1，5 例 mRS 2。15 例患者最后一次随访时显示影像学残留：13 例为单纯颈部残留。未破裂状态和囊状动脉瘤与 mRS 0/1 预后相关（p 值均<0.05）。
在我院，MCA 动脉瘤采用血管内技术治疗，但在少数患者中采用。尽管颈部残留率较高，但需要再次治疗的病例较少，再出血的病例也较少。围手术期并发症发生率不容忽视；因此，在最近几年和目前，我院大多数 MCA 动脉瘤首先考虑夹闭。
