Abstract 373: Predictors of Complete Aneurysm Occlusion in Middle Cerebral Artery Bifurcation Aneurysms: A Multicenter Study on Microsurgical Clipping and Endovascular Strategies

IntroductionMicrosurgical clipping (MC) remains the preferred treatment for middle cerebral artery bifurcation (MCAb) aneurysms, largely due to its superior occlusion rates and proven long‐term efficacy. Endovascular techniques have advanced, providing a range of therapeutic options with promising s...

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Published in:	Stroke: vascular and interventional neurology Vol. 4; no. S1
Main Authors:	Monteiro, A, Jaikumar, V, Rho, K, Lim, J, Kuo, C, Kim, L K, Levitt, M R, Barros, G, Boulos, A, Paul, A, Hanel, R A, Cortez, G, Benalia, V, Jabbour, P, Naamani, K, Nogueira, R, Haussen, D, A Al‐Bayati, Mohammaden, M H, Burkhardt, J, Salem, M M, Schirmer, C, Nickele, C, Johnson, K, Jovin, T, Khalife, J, Kan, P, Colasurdo, M, McGrath, M, Ross, C, Yeradi, M, Devaraju, M, Stafstrom, I, Mokin, M, Thanki, S, Levy, E I, Siddiqui, A H
Format:	Journal Article
Language:	English
Published:	Phoenix Wiley Subscription Services, Inc 01-11-2024
Subjects:	Aneurysms
Online Access:	Get full text
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Summary:	IntroductionMicrosurgical clipping (MC) remains the preferred treatment for middle cerebral artery bifurcation (MCAb) aneurysms, largely due to its superior occlusion rates and proven long‐term efficacy. Endovascular techniques have advanced, providing a range of therapeutic options with promising safety profiles, but a comprehensive evaluation of current treatment modalities for MCAb aneurysms is still lacking.ObjectiveTo evaluate in‐hospital and follow‐up outcomes, complications, and predictors of aneurysm occlusion for MCAb aneurysms across different treatment modalities, including microsurgical clipping (MC), simple coiling (SC), stent‐assisted coiling (SAC), flow diversion (FD), and intra‐saccular flow disruption (FDr).MethodsWe conducted a retrospective review across 9 US centers. Significant univariate predictors (p<0.05) were identified, followed by multivariate multinomial logistic regression to predict Raymond‐Roy Occlusion Classifications immediately post‐intervention (iRROC) and at last follow‐up (fRROC).ResultsA total of 1,060 patients with MCAb aneurysms were analyzed (722 MC, 134 SC, 106 SAC, 34 FD, and 64 FDr). Table 1 shows group characteristics. Univariate analysis showed that iRROC1 was associated with MC, SC, SAC, as well as the presence of wide‐neck aneurysms and aneurysm irregularities. MC and SC were also linked to iRROC2, along with lower Fisher Scores in ruptured aneurysms and the occurrence of intraoperative complications.Multivariate analysis revealed that treatment modality (MC, SAC) and the absence of intraoperative complications significantly predicted iRROC1 and iRROC2, with narrower necks also predicting iRROC1. Notably, a ruptured presentation did not predict iRROC. At last follow‐up, predictors of fRROC1 were ruptured aneurysms with lower Fisher Scores and complete occlusion or neck residuals on immediate postoperative imaging (Table 2).ConclusionMC and SAC demonstrated higher efficacy in achieving iRROC1 in MCAb aneurysms. Endovascular strategies may be a valid therapeutic approach MCAb, potentially minimizing surgical morbidity in high‐risk cases, while providing reasonable occlusion rates.
ISSN:	2694-5746 2694-5746
DOI:	10.1161/SVIN.04.suppl_1.373