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A shift from open to endovascular repair in the treatment of ruptured middle cerebral artery aneurysms: a single institution experience.
Diestro, Jose Danilo Bengzon; Li, Yangmei; Kishore, Kislay; Omar, Abdelsimar T; Montanera, Walter; Sarma, Dipanka; Marotta, Thomas R; Spears, Julian; Bharatha, Aditya.
Afiliación
  • Diestro JDB; Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Canada. danni.diestro@gmail.com.
  • Li Y; Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Canada.
  • Kishore K; Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Canada.
  • Omar AT; Department of Surgery, Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada.
  • Montanera W; Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Canada.
  • Sarma D; Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Canada.
  • Marotta TR; Department of Surgery, Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada.
  • Spears J; Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Canada.
  • Bharatha A; Department of Surgery, Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada.
Neuroradiology ; 65(9): 1353-1361, 2023 Sep.
Article en En | MEDLINE | ID: mdl-37480480
PURPOSE: Middle cerebral aneurysms were underrepresented in the two largest trials (BRAT and ISAT) for the treatment of ruptured intracranial aneurysms. Recent institutional series addressing the choice between endovascular or open repair for this subset of aneurysms are few and have not yielded a definitive conclusion. We compare clinical outcomes of patients presenting with acute subarachnoid hemorrhage from ruptured middle cerebral artery aneurysms undergoing either open or endovascular repair. METHODS: We conducted a retrospective review of 138 consecutive patients with ruptured middle cerebral artery aneurysms admitted into our institution from January 2008 to March 2019 to compare endovascular and open surgical outcomes. RESULTS: Of the ruptured middle cerebral artery aneurysms, 57 underwent endovascular repair while 81 were treated with open surgery. Over the study period, there was a notable shift in practice toward more frequent endovascular treatment of ruptured MCA aneurysms (31% in 2008 vs. 91% in 2018). At discharge (49.1% vs 29.6%; p = .002) and at 6 months (84.3% vs 58.6%; p = 0.003), patients who underwent endovascular repair had a higher proportion of patients with good clinical outcomes (mRS 0-2) compared to those undergoing open surgery. Long-term follow-up data (endovascular 54.9 ± 37.9 months vs clipping 18.6 ± 13.4 months) showed no difference in rebleeding (1.8% vs 3.7%, p = 0.642) and retreatment (5.3% vs 3.7%, p = 0.691) in both groups. CONCLUSION: Our series suggests equipoise in the treatment of ruptured middle cerebral artery aneurysms and demonstrates endovascular repair as a potentially feasible treatment strategy. Future randomized trials could clarify the roles of these treatment modalities.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Hemorragia Subaracnoidea / Aneurisma Intracraneal / Aneurisma Roto / Embolización Terapéutica / Procedimientos Endovasculares Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies Límite: Humans Idioma: En Revista: Neuroradiology Año: 2023 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Alemania
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Hemorragia Subaracnoidea / Aneurisma Intracraneal / Aneurisma Roto / Embolización Terapéutica / Procedimientos Endovasculares Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies Límite: Humans Idioma: En Revista: Neuroradiology Año: 2023 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Alemania