Predictors of recurrence and complications for the endovascular treatment of unruptured middle cerebral artery aneurysm: A high-volume center experience over 12 years

Guoli Duan; Yuhang Zhang; Hongwei Yin; Yina Wu; Xiaoxi Zhang; Rui Zhao; Pengfei Yang; Qiao Zuo; Zhengzhe Feng; Lei Zhang; Dongwei Dai; Yibin Fang; Kaijun Zhao; Qinghai Huang; Bo Hong; Yi Xu; Yu Zhou; Qiang Li; Jianmin Liu

doi:10.1016/j.ejrad.2023.110833

Predictors of recurrence and complications for the endovascular treatment of unruptured middle cerebral artery aneurysm: A high-volume center experience over 12 years

Eur J Radiol. 2023 Jun:163:110833. doi: 10.1016/j.ejrad.2023.110833. Epub 2023 Apr 13.

Authors

Guoli Duan¹, Yuhang Zhang¹, Hongwei Yin¹, Yina Wu¹, Xiaoxi Zhang¹, Rui Zhao¹, Pengfei Yang¹, Qiao Zuo¹, Zhengzhe Feng¹, Lei Zhang¹, Dongwei Dai¹, Yibin Fang², Kaijun Zhao³, Qinghai Huang¹, Bo Hong⁴, Yi Xu¹, Yu Zhou⁵, Qiang Li⁶, Jianmin Liu⁷

Affiliations

¹ Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China.
² Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China; Department of Neurovascular Center, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China.
³ Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China; Department of Neurosurgery, East Hospital Affiliated to Tongji University School of Medicine, Shanghai, China.
⁴ Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China; Department of Neurovascular Center, Shanghai First People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
⁵ Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China. Electronic address: 18317172650@126.com.
⁶ Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China. Electronic address: lqeimm@126.com.
⁷ Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China. Electronic address: liu118@vip.163.com.

PMID: 37080061
DOI: 10.1016/j.ejrad.2023.110833

Abstract

Object: To assess the safety and efficacy of endovascular treatment (EVT) of unruptured middle cerebral artery (MCA) aneurysms in a retrospective cohort in a high-volume center. Predictors of complications and recurrence were determined.

Methods: Retrospectively reviewed our database of prospectively collected information for all patients with unruptured MCA aneurysms that were treated by endovascular approach from March 2008 to December 2020. A multivariate analysis was conducted to identify predictors of complications and recurrence.

Results: Three hundred and fifty-one patients with 370 unruptured MCA aneurysms underwent EVT were included in this study. Seventy-three aneurysms (19.7%) were treated by coiling without stent, 297 (80.3%) with stent-assisted coiling. The procedures were performed with a technical success rate of 100%. Procedure-related neurological complications occurred in 15 patients (4.1%), including 1 patient died from post-procedural stent thrombosis. Age ≥ 65 years (P = 0.039; OR = 3.400; 95% CI, 1.065-10.860) and aneurysm size ≥ 5 mm (P = 0.009; OR = 15.524; 95% CI, 1.988-121.228) were significantly associated with ischemic complications of EVT. Three hundred and six aneurysms were (87.2%) completed image follow-up (235 DSA and 71 CE-MRA). The median angiographic follow-up time were 7.0 ± 4.3 months (range from 1 to 88 months). Follow-up angiograms showed that 249 aneurysms (81.4%) were completed occluded, 29 aneurysms (9.5%) were improved, 17 aneurysms (5.6%) were stable, and 11 aneurysms (3.6%) were recanalized and 10 of them accepted retreatments. Aneurysm size ≥ 10 mm was a predictor of recanalization (P = 0.004; OR = 11.213; 95% CI, 2.127-59.098) and stent-assisted coiling can significantly reduce recanalization (P = 0.004; OR = 0.105; 95% CI, 0.023-0.479).

Conclusions: EVT is a safe and effective therapeutics for unruptured MCA aneurysms management, and provides durable aneurysm occlusion rate during follow-up. Large MCA aneurysms have higher recurrence and ischemic complications risk after EVT. Stent-assisted coiling can significantly reduce the recurrence rate without increasing the risk of complications.

Keywords: Endovascular Treatment; Middle Cerebral Artery Aneurysm; Outcome; Risk factor; Unruptured.

MeSH terms

Aged
Cerebral Angiography / methods
Embolization, Therapeutic* / methods
Endovascular Procedures* / methods
Humans
Intracranial Aneurysm* / diagnostic imaging
Intracranial Aneurysm* / surgery
Retrospective Studies
Stents / adverse effects
Treatment Outcome