Endovascular coil placement compared with surgical clipping for the treatment of unruptured middle cerebral artery aneurysms: a consecutive series.

Détails

ID Serval
serval:BIB_B1753F711EE4
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Endovascular coil placement compared with surgical clipping for the treatment of unruptured middle cerebral artery aneurysms: a consecutive series.
Périodique
Journal of Neurosurgery
Auteur(s)
Regli L., Uske A., de Tribolet N.
ISSN
0022-3085
Statut éditorial
Publié
Date de publication
06/1999
Peer-reviewed
Oui
Volume
90
Numéro
6
Pages
1025-1030
Langue
anglais
Résumé
OBJECT: The goal of this study was to delineate the angioanatomical features that determine whether a patient with an unruptured middle cerebral artery (MCA) aneurysm is treated using endovascular coil placement or surgical clipping. METHODS: Thirty consecutive patients harboring 34 unruptured MCA aneurysms were evaluated. Patients with unruptured aneurysms are managed prospectively according to the following protocol: the primary treatment recommendation is endovascular packing with Guglielmi detachable coils (GDCs). Surgical clipping is recommended after failed attempts at coil placement or in the presence of angioanatomical features that contraindicate that type of endovascular therapy. Of 34 unruptured MCA aneurysms, two (6%) were successfully embolized and 32 (94%) were clipped. Of these 32 surgically treated aneurysms, in 11 (34%) an attempt at GDC embolization had failed, whereas in 21 (66%) primary clipping was performed because of unfavorable angioanatomy. Of the 13 aneurysms treated endovascularly, two (15%) were successfully excluded, whereas GDC treatment failed in 11 (85%). An unfavorable dome/neck ratio (< 2) and an arterial branch originating at the aneurysm base were the reasons for embolization failure. CONCLUSIONS: Careful evaluation of the angioanatomy of unruptured aneurysms allows selection of the most appropriate treatment. However, for unruptured MCA aneurysms, surgical clipping appears to be the most efficient treatment option. Series of unruptured aneurysms are ideal for comparing treatment results.
Mots-clé
Adult, Aneurysm, Ruptured/therapy, Angiography, Digital Subtraction, Cerebral Angiography, Cerebral Arteries/surgery, Embolization, Therapeutic/instrumentation, Female, Humans, Intracranial Aneurysm/radiography, Intracranial Aneurysm/surgery, Male, Middle Aged, Postoperative Complications, Treatment Failure, Treatment Outcome
Pubmed
Web of science
Création de la notice
10/04/2008 17:52
Dernière modification de la notice
03/03/2018 20:36
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