Kijima Noriyuki, Miura Shimpei, Terada Eisaku, Nakagawa Ryota, Tachi Tetsuro, Murakami Koki, Okita Yoshiko, Kanemura Yonehiro, Nakajima Shin, Fujinaka Toshiyuki
Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Osaka, Osaka, Japan.
Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
J Neuroendovasc Ther. 2021;15(4):213-219. doi: 10.5797/jnet.oa.2019-0051. Epub 2020 Nov 26.
The efficacy of endovascular treatment for middle cerebral artery (MCA) aneurysms remains controversial. However, recent studies have reported the safety of endovascular treatment for MCA aneurysms. In this study, we studied the efficacy and clinical outcomes of endovascular treatment for MCA aneurysms in our hospital and the morphology and anatomy of MCA aneurysms that were suitable for endovascular treatment.
We retrospectively analyzed 26 cases of MCA aneurysms which had undergone endovascular treatment at our institution between January 2015 and October 2018. We studied sizes and shapes of the aneurysms, clinical and angiographical outcomes one year after the treatment, and complications in these 26 patients. We also compared the differences in these parameters of the 26 patients with those of 61 other patients who were treated with clipping during the same period.
The median aneurysm size was 6.1 mm (1.8-29.9 mm), with the shapes of the aneurysms irregular in 8, and round in the other 18 cases. Four cases (15.4%) had ruptured aneurysms. All aneurysms were treated with assist techniques; 8 (30.8%) were treated by stent-assisted technique and 18 (69.2%) were treated by balloon-assisted technique and endovascular treatment was successfully performed in all (100%) cases. While the aneurysms were completely obliterated in 22 of them (84.6%), the remaining 4 cases (15.4%) had neck remnants. We observed periprocedural complications in 5 of the 26 (19.2%) aneurysms, all of which were transient and completely recovered during the follow-up period. The efficacy and complication rates were not different from the MCA aneurysms treated with clipping. All MCA aneurysms arising from the M1 trunk were treated with endovascular treatment, and those with a round shape with the axis not deviating from M1 were also treated with endovascular treatment.
Endovascular treatment for MCA aneurysms is safe and effective together with adjunctive techniques such as balloon-assisted technique or stent-assisted technique. Thus, M1 trunk aneurysms and MCA bifurcation aneurysms with a round shape along the same axis of MCA may be good indications for endovascular treatment. However, long-term clinical and angiographical outcomes remain unknown. Thus, further studies are needed to address the existing limitations.
大脑中动脉（MCA）动脉瘤的血管内治疗疗效仍存在争议。然而，近期研究报道了MCA动脉瘤血管内治疗的安全性。在本研究中，我们探讨了我院MCA动脉瘤血管内治疗的疗效和临床结局，以及适合血管内治疗的MCA动脉瘤的形态和解剖结构。
我们回顾性分析了2015年1月至2018年10月在我院接受血管内治疗的26例MCA动脉瘤患者。我们研究了动脉瘤的大小和形状、治疗后一年的临床和血管造影结局以及这26例患者的并发症。我们还将这26例患者的这些参数与同期接受夹闭治疗的61例其他患者的参数进行了比较。
动脉瘤中位大小为6.1mm（1.8 - 29.9mm），其中8例动脉瘤形状不规则，18例呈圆形。4例（15.4%）为破裂动脉瘤。所有动脉瘤均采用辅助技术治疗；8例（30.8%）采用支架辅助技术治疗，18例（69.2%）采用球囊辅助技术治疗，所有（100%）病例血管内治疗均成功进行。其中22例（84.6%）动脉瘤完全闭塞，其余4例（15.4%）有颈部残留。我们观察到26例动脉瘤中有5例（19.2%）出现围手术期并发症，所有并发症均为短暂性，随访期间完全恢复。其疗效和并发症发生率与接受夹闭治疗的MCA动脉瘤无差异。所有起源于M1主干的MCA动脉瘤均采用血管内治疗，对于形状为圆形且轴线不偏离M1的动脉瘤也采用血管内治疗。
采用球囊辅助技术或支架辅助技术等辅助手段，MCA动脉瘤的血管内治疗安全有效。因此，M1主干动脉瘤以及沿MCA同一轴线呈圆形的MCA分叉动脉瘤可能是血管内治疗的良好适应证。然而，长期临床和血管造影结局尚不清楚。因此，需要进一步研究以解决现有局限性。
