From the Department of Diagnostic and Interventional Neuroradiology, Klinikum Augsburg, Augsburg, Germany.
AJNR Am J Neuroradiol. 2019 Mar;40(3):503-509. doi: 10.3174/ajnr.A5977. Epub 2019 Feb 14.
The optimal treatment of unruptured middle cerebral aneurysms is still under debate. Although today almost any aneurysm can be treated endovascularly, there is a lack of data comparing endovascular and microsurgical repair of MCA aneurysms. The aim of our analysis is to provide data on the efficacy, clinical outcome, complications and re-treatment rates of endovascular treatment of this subtype of aneurysms.
Between May 2008 and July 2017, endovascular treatment of 1184 aneurysms in 827 patients was performed in our department. Twenty-four percent of these aneurysms were located at the MCA, and 150 unruptured MCA bifurcation aneurysms treated with coiling, stent-assisted-coiling, or endovascular flow diverter (WEB device) were identified for this retrospective data analysis. Ninety-six percent of all aneurysms, ruptured and unruptured, were treated by an endovascular approach, which yields a low selection bias for aneurysms suitable for endovascular treatment. Follow-up examinations were performed after 12 and 36 months and then every 1-3 years after embolization. Procedures were analyzed for periprocedural complications, outcome, and retreatment rate of the WEB ( = 38) and coiling with ( = 45) or without stent assistance ( = 67).
The procedure-associated good clinical outcome (mRS ≦ 2) was 89.9%, and the mortality rate was 2.7%. Short-term follow-up good clinical outcome/mortality rates were 91.3%/0.7%. At discharge, 137 patients had an mRS of 0-2 (91.3%) and 13 had an mRS of 3-6 (8.7%). The retreatment rate was significantly higher in the WEB group (21.1%) compared with the coiling group with (5.9%) or without (2.2%) stent placement ( < .05).
Regardless of the architecture of MCA bifurcation aneurysms, the endovascular treatment can be performed with low morbidity/mortality rates. The higher retreatment rate in the WEB group correlates with the learning curve in choosing the right device size.
未破裂的大脑中动脉动脉瘤的最佳治疗方法仍存在争议。尽管今天几乎任何动脉瘤都可以进行血管内治疗，但缺乏比较大脑中动脉动脉瘤血管内和显微修复的疗效数据。我们分析的目的是提供关于这种亚型动脉瘤血管内治疗的疗效、临床结果、并发症和再治疗率的数据。
在 2008 年 5 月至 2017 年 7 月期间，我们科室对 827 名患者的 1184 个动脉瘤进行了血管内治疗。这些动脉瘤中有 24%位于大脑中动脉，其中 150 个未破裂的大脑中动脉分叉动脉瘤采用线圈、支架辅助线圈或血管内血流分流器（WEB 装置）进行治疗，用于回顾性数据分析。所有动脉瘤（破裂和未破裂）中有 96%采用血管内方法治疗，这使得适合血管内治疗的动脉瘤的选择偏差很低。栓塞后 12 个月和 36 个月进行随访检查，然后每 1-3 年进行一次随访。分析了 WEB （=38）和线圈（=45）或无支架辅助（=67）的围手术期并发症、结果和再治疗率。
手术相关的良好临床结果（mRS≤2）为 89.9%，死亡率为 2.7%。短期随访的良好临床结果/死亡率分别为 91.3%/0.7%。出院时，137 例患者的 mRS 为 0-2（91.3%），13 例患者的 mRS 为 3-6（8.7%）。WEB 组的再治疗率明显高于线圈组（5.9%）或无支架组（2.2%）（<0.05）。
无论大脑中动脉分叉动脉瘤的结构如何，血管内治疗都可以以较低的发病率/死亡率进行。WEB 组较高的再治疗率与选择合适的装置尺寸的学习曲线有关。
