Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
Neuroradiology. 2013 Sep;55(9):1097-102. doi: 10.1007/s00234-013-1190-5. Epub 2013 Jun 13.
Proximal middle cerebral artery (M1 segment) aneurysms have various configurations and are distinct from middle cerebral artery bifurcation aneurysms. We present the clinical and radiological results of coil embolization of the M1 segment aneurysms.
From a prospective database, we retrieved the data for 59 consecutive patients harboring 60 M1 aneurysms that were treated with endovascular coil embolization from January 2006 to May 2012. We assessed the clinical outcomes of the patients and morphological outcomes of the aneurysms using the Raymond classification.
The aneurysms were located on the superior wall of the M1 segment in 43 and on the inferior wall in 17. Superior-wall aneurysms were related to the frontal cortical artery and the lateral lenticulostriate perforator while inferior-wall aneurysms were to the temporal cortical artery. With coil embolization, complete aneurysmal occlusion or residual neck could be achieved in 52 aneurysms (86.7 %) and residual aneurysm in 8. The microcatheter protection technique was most commonly used for coil embolization (41.7 %) followed by single microcatheter (31.7 %), double microcatheter (23.3 %), and stent protection (3.3 %). There was no procedure-related morbidity or mortality. Follow-up angiography more than 6 months after embolization (n = 46; mean 12.4 months) demonstrated stable occlusion in 40 (87.0 %), minor recanalization in 4 (8.7 %), and major recanalization in 2 (4.3 %). One patient experienced delayed cerebral infarction without permanent neurologic deficit.
Coil embolization in M1 aneurysms seems to be safe and efficacious, although it may require various technical strategies due to distinct anatomic configurations.
大脑中动脉近段（M1 段）动脉瘤具有多种形态，与大脑中动脉分叉部动脉瘤不同。我们报告了用血管内线圈栓塞治疗 M1 段动脉瘤的临床和影像学结果。
从一个前瞻性数据库中，我们检索了 2006 年 1 月至 2012 年 5 月期间连续 59 例 60 个 M1 段动脉瘤患者的资料，这些患者均接受了血管内线圈栓塞治疗。我们采用 Raymond 分级评估患者的临床转归和动脉瘤的形态学结果。
动脉瘤位于 M1 段的上壁 43 例，下壁 17 例。上壁动脉瘤与额皮质动脉和外侧纹状体穿通支有关，而下壁动脉瘤与颞皮质动脉有关。用线圈栓塞治疗后，52 个动脉瘤（86.7%）达到完全闭塞或瘤颈残留，8 个动脉瘤仍有残留。最常用的线圈栓塞技术是微导管保护技术（41.7%），其次是单微导管（31.7%）、双微导管（23.3%）和支架保护（3.3%）。无与手术相关的发病率或死亡率。栓塞后超过 6 个月（n=46；平均 12.4 个月）的随访血管造影显示 40 个动脉瘤（87.0%）稳定闭塞，4 个动脉瘤（8.7%）轻微再通，2 个动脉瘤（4.3%）明显再通。1 例患者发生迟发性脑梗死，但无永久性神经功能缺损。
M1 段动脉瘤的线圈栓塞似乎是安全有效的，尽管由于其独特的解剖结构，可能需要采用各种技术策略。
