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Related Concept Videos

Aneurysm III: Interprofessional Care01:26

Aneurysm III: Interprofessional Care

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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
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Stent placement for complex middle cerebral artery aneurysms.

Yu Zhou1, Peng-Fei Yang1, Qiang Li1

  • 1Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|April 30, 2014
PubMed
Summary

Stent placement is a feasible and effective treatment for wide-neck middle cerebral artery (MCA) aneurysms. However, ruptured MCA aneurysms treated with stents have a significantly higher complication rate.

Keywords:
Stentaneurysmsmiddle cerebral arteryrupturedunruptured

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Area of Science:

  • Neurosurgery
  • Interventional Neurology
  • Vascular Neurology

Background:

  • Middle cerebral artery (MCA) aneurysms pose significant risks.
  • Stent placement is an emerging treatment option for complex MCA aneurysms.
  • Evaluating stent safety and efficacy in a larger patient cohort is crucial.

Purpose of the Study:

  • To assess the safety and effectiveness of stent placement for treating middle cerebral artery (MCA) aneurysms.
  • To compare outcomes between ruptured and unruptured MCA aneurysms treated with stents.
  • To identify factors influencing the outcomes of stent placement for MCA aneurysms.

Main Methods:

  • Retrospective analysis of 70 patients with 72 complex MCA aneurysms treated with stents between 2003 and 2012.
  • Procedures included stent-assisted coiling and stent-alone placement.
  • Clinical and angiographic follow-up data were collected and analyzed.

Main Results:

  • Eighty-five stents were successfully deployed with a low rate of coiling failure (2.8%).
  • Complete occlusion rates varied: 34.9% with stent-assisted coiling and 0% with stent alone.
  • Complication rates were higher in ruptured aneurysms (25.9%) compared to unruptured (4.4%), with a 12.5% overall complication rate.
  • Ruptured aneurysm status was an independent predictor of adverse outcomes (OR, 7.35).
  • Angiographic follow-up showed 72.1% complete occlusion, with a low rate of recurrence (4.9%) and intrastent stenosis (1.6%).
  • Clinical follow-up demonstrated stable or improved status in most patients, with procedure-related morbidity/mortality of 3.7%/3.7% for ruptured and 0%/0% for unruptured aneurysms.

Conclusions:

  • Stent placement is a feasible, safe, and effective treatment for select wide-neck MCA aneurysms.
  • Acutely ruptured MCA aneurysms treated with stents exhibit a substantially higher complication rate.
  • Careful patient selection and risk assessment are vital when considering stent placement for MCA aneurysms, particularly in ruptured cases.