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Updated: Jun 12, 2026
Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
Flow Diversion for Middle Cerebral Artery Aneurysms: Clinical and Angiographic Results from a Single-Center
Francisco Rubilar1, Iván Lylyk2, Pedro Nicolás Lylyk2
1From the Interventional Neuroradiology (F.R., I.L., P.N.L., N.P., C.D.B., E.S., J.L., R.N.C., P.Y., P.L.), Instituto Médico ENERI, Buenos Aires, Argentina and Department of Neurosurgery (F.R.), Clínica Universidad de Los Andes, Santiago, Chile. fjrubilar@miuandes.cl.
Background And Purpose:
MCA aneurysms remain challenging to treat due to their complex bifurcational anatomy and eloquent branch incorporation. The role of flow diversion in this location has been controversial. The aim of this study was to evaluate the efficacy and safety of flow diverters (FDs) for MCA aneurysms in a single-center cohort.
Materials And Methods:
This retrospective single-center study included 139 patients with a MCA aneurysm treated with FD between 2017 and 2024. Clinical, radiological, and procedural data were collected. Follow-up imaging (DSA, MRA, CTA) was obtained at 6, 12, and 24 months, with postoperative MRI with diffusion-weighted imaging (DWI) used to assess ischemic lesions. Outcomes were evaluated using the mRS, and predictors of occlusion were analyzed.
Results:
A total of 139 patients (150 aneurysms) were treated, with a mean age of 55.6 years and 73.4% female. Most aneurysms were small (≤5 mm, 61%) and saccular (89%). At a mean angiographic follow-up of 17.1 months, complete occlusion was achieved in 55.1%, and adequate occlusion (OKM C-D) in 76.4% of aneurysms. The p48 MW-HPC and PED Vantage devices achieved the highest adequate occlusion rates (91.7% and 89.5%, respectively). Complications occurred in 9.5% of patients, with three permanent deficits (2.6%) and mortality of 0.9%.
Conclusions:
Flow diversion for MCA aneurysms demonstrated high efficacy and low morbidity, with progressive occlusion and excellent clinical tolerance. Hemodynamic flow diversion likely contributes to aneurysm exclusion, complementing the mechanical effect of neck coverage. Strict adherence to a prasugrel-aspirin protocol and individualized platelet management contributed to the low ischemic and fatal event rates observed.
