gms | German Medical Science

Objective: In the treatment of unruptured intracranial aneurysms, endovascular coiling has shown equal or superior results to clipping. But for unruptured MCA-aneurysms, coiling has been limited. The study analyzes ruptured and non ruptured aneurysms with respect to their geometry in a pre-treatment group. In a second group of unruptured MCA-aneurysms, the endovascular treatment results are evaluated.

Methods: For morphology comparison, 126 MCA aneurysms were classified according their anatomical appearance. In a separate group of 70 patients (30 men, 40 women, 22-77 years, mean age 59) with 76 unruptured MCA-aneurysms the technique of treatment and clinical results were evaluated.

Results: The location of the aneurysms was at the media trifurcation in 73%, M1-segment in 22% and MCA branch in 5%. A large neck was found in 53.9% and a narrow neck in 46.1%. For treatment modalities, a single catheter technique, multi-catheter technique, balloon-assisted coiling, stent-assisted coiling and multi-catheter with balloon technique were used. The failure rate for coiling was 1.3%, periprocedural complications occurred in 1.4 % and transient ischemic events in 2.8%; persistent morbidity was 1.4 % and the mortality rate was 1.4%. A minimal partial recanalization was seen in 8.6% on follow-up angiography (6–24 months, mean 11 months). A clear recurrence was found in 4.3%.

Conclusions: ACM aneurysms should not be allocated solely to clipping since they are well treatable endovascularly with good results.