1096. Flow Diversion for the Treatment of Intracranial Middle Cerebral Artery Aneurysms: A Single Center Experience

Authors: Jaime R. Guerrero; Jonathan Lee, MD; Nikhil Pai, BS; Jonathan Zhang, MD; Orlando Diaz, MD; Richard Klucznick, MD; Gavin Britz, MD (McAllen, TX)

Introduction: Intracranial middle cerebral artery (MCA) aneurysms represent about one third of all anterior circulation aneurysms. These aneurysms are commonly treated via open surgical approach often due to their unfavorable geometry and high recanalization rates. In this case series we describe the first fourteen flow diversion interventions on M1 intracranial aneurysms at a single center in the last 5 years. The specific morphology, devices used, complications, and occlusions rates at follow up are described. Methods: Fourteen patients with M1 intracranial aneurysms from 2013-2017 were treated with endovascular flow diversion at our institution. Patient age ranged from 47-73 years old with 6 males and 8 females. Aneurysm dome size ranged from 3-10 mm. Two patients had undergone previous surgical clipping of the same aneurysm with subsequent recanalization. Eleven of fourteen patients were treated with the LVIS Jr. stent, two with a combination of Enterprise 2 and LVIS stents, and one with a Pipeline stent. Ten of fourteen (71%) patients were treated with concurrent coil embolization while two patients underwent coil embolization at a later time. Results: Thirteen patients (93%) achieved complete angiographic obliteration of their M1 aneurysms after flow diversional therapy. Of those thirteen, twelve patients (92%) underwent additional coil embolization to achieve complete angiographic obliteration. One patient with a dissecting pseudoaneurysm suffered post-operative cardiac arrest. Three patients (21%) sustained perioperative ischemic strokes, one (7%) with postoperative seizure and one (7%) with post-operative mild hemiparesis without evidence of thrombus or ischemia. Conclusion: In this case series, we demonstrate the utility and success of stent-assisted coil embolization of M1 aneurysms using flow diversion at a single institution. Complete angiographic obliteration rates approached 93% with limited complications.