AJR: Endovascular coiling safe for cerebral aneurysms

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Endovascular treatment of middle cerebral artery aneurysms is safe, and long-term monitoring of patients showed a low rate of recurrence requiring retreatment, according to a retrospective review in this month’s issue of the American Journal of Roentgenology.

Jean-François Vendrell, MD, from the department of neuroradiology at the University Hospital Center in Cedex, France, and colleagues evaluated the immediate safety and efficacy, as well as the clinical outcome and long-term angiographic results, of endovascular treatment of middle cerebral artery aneurysms.

In this retrospective review of patients in whom coiling of middle cerebral artery aneurysms was attempted over a seven-year period, researchers included 153 patients with 174 middle cerebral artery aneurysms (71 unruptured, 103 ruptured). Complications of endovascular treatment, clinical outcome and the results of either cerebral digital subtraction angiography or MR angiography were analyzed at initial, intermediate (six–18 months) and late (two–seven years) follow up.

Investigators performed coiling in 92 percent of aneurysms in 141 patients. They observed peri-procedural complications in 19.4 percent of procedures, including aneurysm perforations (4.4 percent) and thromboembolic events (15 percent).

Endovascular treatment induced permanent morbidity in eight patients, with severe neurologic impairment in three, and two deaths, according to the authors. Of 114 middle cerebral artery aneurysms controlled by using digital subtraction angiography (50 participants) or MR angiography (64 participants) at 50 months, 64 percent remained completely occluded, 27.2 percent recurred and 10.5 percent of the major recurrences were retreated.

Vendrell and colleagues also reported that a balloon remodeling technique allowed treatment of complex aneurysms (63 participants) but was associated with more recurrences in the long term (42.6 percent) than aneurysms treated without balloon assistance (16.4 percent).

The authors determined that endovascular coiling was safe and had a low rate of recurrence requiring treatment. They recommended, however, that complex anatomy and long-term recurrences should be addressed when considering endovascular treatment for middle cerebral artery aneurysms.