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Comparative analysis of microsurgical clipping versus endovascular coiling for middle cerebral artery aneurysms: a prospective study at Ain Shams University hospitals

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Title: Comparative analysis of microsurgical clipping versus endovascular coiling for middle cerebral artery aneurysms: a prospective study at Ain Shams University hospitals
Authors: Mohamed Khamis, Hamdy Ibrahim, Ahmed M.Elsayed, Sameh R. Tawadros, Mohamed Helmy Abdelshafouk Mohamed, K. El-Bahy
Source: Egyptian Journal of Neurosurgery, Vol 40, Iss 1, Pp 1-15 (2025)
Publisher Information: SpringerOpen, 2025.
Publication Year: 2025
Collection: LCC:Surgery
LCC:Neurosciences. Biological psychiatry. Neuropsychiatry
Subject Terms: MCA aneurysm, Clipping, Coiling, Endovascular, Intracranial aneurysm, Surgery, RD1-811, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571
More Details: Abstract Background The treatment landscape for intracranial aneurysms (IAs), particularly those involving the middle cerebral artery (MCA), has evolved significantly over the past two decades. The pivotal International Subarachnoid Aneurysm Trial (ISAT) of 2002 heralded a paradigm shift toward endovascular coiling as the preferred treatment modality for ruptured IAs, prompting a widespread adoption of this approach in neurosurgical centers worldwide. However, despite the initial enthusiasm for coiling, microsurgical clipping remains the cornerstone of treatment for MCA aneurysms in experienced cerebrovascular centers due to its superior efficacy in achieving complete aneurysm occlusion and minimizing long-term recurrence rates. Objective We aimed to compare the effectiveness and safety of microsurgical clipping versus endovascular coiling for middle cerebral artery (MCA) aneurysms, focusing on rates of occlusion, procedural complications, and long-term neurological outcomes. Methods We prospectively analyzed 40 patients with ruptured and unruptured MCA aneurysms presented at Ain Shams University Hospital neurosurgical department from January 2021 to December 2023 and they underwent microsurgical clipping or endovascular coiling. Results In patients treated with microsurgical clipping for MCA aneurysms, commonly associated with hypertension, smoking, and drug abuse, favorable clinical grades were observed, with most aneurysms located at bifurcations. Intra-operative complications, primarily premature rupture, led to a 12.45-day hospital stay, with post-operative issues including vasospasm-related strokes and infections. Six-month follow-up showed a 65% favorable outcome. Conversely, in 20 patients treated with endovascular coiling, typically for ruptured aneurysms, hypertension, and smoking were prevalent risk factors, with fewer complications during hospitalization (average 4.2 days). At 6-month and 1-year follow-ups, complete occlusion rates were 85% and 80%, respectively, with some cases requiring further intervention due to incomplete occlusion. Conclusion While endovascular coiling has revolutionized the management of intracranial aneurysms, surgical clipping remains a vital treatment option, offering superior outcomes in select cases, particularly those involving MCA aneurysms. A balanced approach, tailored to individual patient characteristics and institutional expertise, is essential to optimize treatment outcomes and minimize the risk of recurrence and re-rupture in this challenging patient population.
Document Type: article
File Description: electronic resource
Language: English
ISSN: 2520-8225
Relation: https://doaj.org/toc/2520-8225
DOI: 10.1186/s41984-024-00338-w
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  Data: Abstract Background The treatment landscape for intracranial aneurysms (IAs), particularly those involving the middle cerebral artery (MCA), has evolved significantly over the past two decades. The pivotal International Subarachnoid Aneurysm Trial (ISAT) of 2002 heralded a paradigm shift toward endovascular coiling as the preferred treatment modality for ruptured IAs, prompting a widespread adoption of this approach in neurosurgical centers worldwide. However, despite the initial enthusiasm for coiling, microsurgical clipping remains the cornerstone of treatment for MCA aneurysms in experienced cerebrovascular centers due to its superior efficacy in achieving complete aneurysm occlusion and minimizing long-term recurrence rates. Objective We aimed to compare the effectiveness and safety of microsurgical clipping versus endovascular coiling for middle cerebral artery (MCA) aneurysms, focusing on rates of occlusion, procedural complications, and long-term neurological outcomes. Methods We prospectively analyzed 40 patients with ruptured and unruptured MCA aneurysms presented at Ain Shams University Hospital neurosurgical department from January 2021 to December 2023 and they underwent microsurgical clipping or endovascular coiling. Results In patients treated with microsurgical clipping for MCA aneurysms, commonly associated with hypertension, smoking, and drug abuse, favorable clinical grades were observed, with most aneurysms located at bifurcations. Intra-operative complications, primarily premature rupture, led to a 12.45-day hospital stay, with post-operative issues including vasospasm-related strokes and infections. Six-month follow-up showed a 65% favorable outcome. Conversely, in 20 patients treated with endovascular coiling, typically for ruptured aneurysms, hypertension, and smoking were prevalent risk factors, with fewer complications during hospitalization (average 4.2 days). At 6-month and 1-year follow-ups, complete occlusion rates were 85% and 80%, respectively, with some cases requiring further intervention due to incomplete occlusion. Conclusion While endovascular coiling has revolutionized the management of intracranial aneurysms, surgical clipping remains a vital treatment option, offering superior outcomes in select cases, particularly those involving MCA aneurysms. A balanced approach, tailored to individual patient characteristics and institutional expertise, is essential to optimize treatment outcomes and minimize the risk of recurrence and re-rupture in this challenging patient population.
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      – SubjectFull: MCA aneurysm
        Type: general
      – SubjectFull: Clipping
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      – SubjectFull: Coiling
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