Frontiers in neurology · 2026
Flow diverter treatment for MCA M1 aneurysms: clinical outcomes and predictors of occlusion.
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Yu Zeran, Su Jiabin, Gao Xinjie, Weng Ruiyuan, Fei Yuchao, Yang Heng, Gu Yuxiang, Ni Wei
Аннотация
BACKGROUND: The role of flow diverters (FDs) in middle cerebral artery (MCA) M1 aneurysms is not well established. We assessed their safety, efficacy, and predictors of incomplete occlusion.
METHODS: Consecutive MCA M1 aneurysms treated with FDs (January 2022-May 2024) were retrospectively reviewed. Clinical, imaging, and procedural variables were analyzed for associations with ischemic complications and angiographic outcomes.
RESULTS: Fifty-eight patients (mean age 57.5 years; 46.6% female) underwent treatment with Pipeline (56.9%), Tubridge (20.7%), Surpass Evolve (12.1%), or Lattice (10.3%) devices. Postprocedural cerebral ischemia occurred in 25.9% (15/58), significantly more often in ruptured versus unruptured aneurysms (26.7% vs. 2.3%, p = 0.013). Rupture independently predicted ischemia (OR 15.273, 95% CI 1.547-150.765; p = 0.020). At a median follow-up of 13 months, complete occlusion was achieved in 77.4% (41/53). Aneurysm wall enhancement on MRI independently predicted incomplete occlusion (OR 6.566, 95% CI 1.395-30.903; p = 0.017).
CONCLUSION: FDs may be an option for carefully selected MCA M1 aneurysms. Ruptured aneurysms are associated with a markedly higher risk of postoperative ischemic complications, and aneurysm wall enhancement on preoperative MRI independently predicts incomplete aneurysm occlusion after FDs treatment.
METHODS: Consecutive MCA M1 aneurysms treated with FDs (January 2022-May 2024) were retrospectively reviewed. Clinical, imaging, and procedural variables were analyzed for associations with ischemic complications and angiographic outcomes.
RESULTS: Fifty-eight patients (mean age 57.5 years; 46.6% female) underwent treatment with Pipeline (56.9%), Tubridge (20.7%), Surpass Evolve (12.1%), or Lattice (10.3%) devices. Postprocedural cerebral ischemia occurred in 25.9% (15/58), significantly more often in ruptured versus unruptured aneurysms (26.7% vs. 2.3%, p = 0.013). Rupture independently predicted ischemia (OR 15.273, 95% CI 1.547-150.765; p = 0.020). At a median follow-up of 13 months, complete occlusion was achieved in 77.4% (41/53). Aneurysm wall enhancement on MRI independently predicted incomplete occlusion (OR 6.566, 95% CI 1.395-30.903; p = 0.017).
CONCLUSION: FDs may be an option for carefully selected MCA M1 aneurysms. Ruptured aneurysms are associated with a markedly higher risk of postoperative ischemic complications, and aneurysm wall enhancement on preoperative MRI independently predicts incomplete aneurysm occlusion after FDs treatment.