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Flow diverter treatment for MCA M1 aneurysms: clinical outcomes and predictors of occlusion

Zeran Yu1,2,3,4, Jiabin Su1,2, Xinjie Gao1,2

  • 1Department of Neurosurgery, Huashan Hospital of Fudan University, Shanghai, China.

Frontiers in Neurology
|April 20, 2026
PubMed
Abstract

Insights

Flow diverters (FDs) offer a treatment option for middle cerebral artery (MCA) M1 aneurysms. Ruptured aneurysms increase ischemic risk, while MRI-detected wall enhancement predicts incomplete occlusion.

Area of Science:

  • Neuroendovascular therapy
  • Cerebrovascular disease management
  • Medical device innovation

Background:

  • The efficacy and safety of flow diverters (FDs) for middle cerebral artery (MCA) M1 aneurysms remain under investigation.
  • Assessing predictors of incomplete occlusion is crucial for optimizing treatment outcomes.

Purpose of the Study:

  • To evaluate the safety and efficacy of FDs in treating MCA M1 aneurysms.
  • To identify factors associated with incomplete aneurysm occlusion and postoperative ischemic complications.

Main Methods:

  • Retrospective review of consecutive MCA M1 aneurysms treated with FDs between January 2022 and May 2024.
  • Analysis of clinical, imaging, and procedural variables to determine associations with ischemic events and angiographic results.

Main Results:

  • Postprocedural cerebral ischemia occurred in 25.9% of patients, with a significantly higher incidence in ruptured aneurysms (26.7% vs. 2.3%).
  • Rupture was an independent predictor of ischemia (OR 15.273).
  • Complete occlusion was achieved in 77.4% of aneurysms at a median 13-month follow-up, with aneurysm wall enhancement on MRI predicting incomplete occlusion (OR 6.566).

Conclusions:

  • Flow diverters represent a potential treatment for select MCA M1 aneurysms.
  • Ruptured aneurysms carry a substantially higher risk of postoperative ischemic complications.
  • Preoperative MRI evidence of aneurysm wall enhancement is an independent predictor of incomplete occlusion following FD treatment.
Keywords:
aneurysm occlusioncerebral middle arteryendovascular treatmentflow diverter devicesintracranial aneurysmischemic complication

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