Aneurysm Clinical and anatomic outcomes after endovascular coiling of middle cerebral artery aneurysms: report on 30 treated aneurysms and review of the literature Michael Horowitz, MD a,b, 4 , Rishi Gupta, MD a,d , Yakov Gologorsky, BA a , Tudor Jovin, MD a,d , Julie Genevro, RN, BSN c , Elad Levy, MD e , Amin Kassam, MD a,f Departments of a Neurosurgery, and b Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA c University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA d Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA e Department of Neurosurgery, University of Buffalo, Buffalo, NY 14209, USA f Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA Received 21 July 2005; accepted 12 December 2005 Abstract Background: Endovascular treatment of middle cerebral artery (MCA) aneurysms has not been extensively studied. We report our experience on a select group of patients that underwent coil embolization of an MCA bifurcation aneurysm. Methods: From August 1999 to January 2005, 29 patients harboring 30 MCA aneurysms were treated with coil embolization. These patients were felt to have favorable characteristics for endovascular therapy including absence of thrombus in the aneurysm, absence of an efferent artery off of the aneurysm, and ability to reconstruct the wide neck with stent reconstruction. We retrospectively reviewed their records and angiographic images to evaluate for technical result and complications. Results: The mean age of our cohort was 59 F 13 years with 19 patients presenting with a ruptured aneurysm. Complete obliteration was achieved in 24 (80%) of 30 of aneurysms on postprocedural angiography and no patient showed aneurysm regrowth at 6-month follow-up. Twenty-seven (93%) of 29 patients had no change in baseline neurological function post-embolization. There were two procedural-related complications: one intraprocedural rupture of an aneurysm and one thromboem- bolic stroke in the ipsilateral MCA territory. Conclusions: Coil embolization of MCA bifurcation aneurysms has a high rate of complete obliteration with acceptable morbidity in our selected group of patients. D 2006 Elsevier Inc. All rights reserved. Keywords: Aneurysm; Middle cerebral artery; Coil embolization 1. Introduction Since 1994, endovascular therapy for intracranial aneur- ysms has grown in popularity. The results of the ISAT have done much to make aneurysm coiling acceptable [3]. An important endeavor is to determine which aneurysm sub- populations should be treated using current endovascular techniques. Much of this evaluation revolves around aneu- rysm morphology that is dependent on aneurysm location. Little has been published with regard to the endovascular treatment of MCA aneurysms. Middle cerebral artery 0090-3019/$ – see front matter D 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.surneu.2005.12.022 Abbreviations: F/N, fundus to neck ratio; ISAT, International Sub- arachnoid Aneurysm Trial; MCA, middle cerebral artery; mRS, modified Rankin Score. 4 Corresponding author. Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. Tel.: +1 412 647 6358; fax: +1 412 647 0989. E-mail address: horowitzmb@upmc.edu (M. Horowitz). Surgical Neurology 66 (2006) 167 – 171 www.surgicalneurology-online.com