Endovascular Treatment for the Middle Cerebral Artery Hilltop Aneurysm

Introduction: M1 segment of middle cerebral artery (MCA) aneurysm is a relatively rare clinical condition. However, due to its complex geometry and deep location, microsurgical treatment is challenging. With the development of devices and techniques, a range of aneurysms can be treated with endovascular treatment.

Method(s): Of 757 MCA aneurysm between December 2017 and October 2021, 54 M1 segment aneurysms were treated with EVT, and these aneurysms were designated M1 hilltop aneurysms. Clinical and radiographic data, including aneurysm characteristics, endovascular techniques, angiographic outcome, procedure-related complications, and clinical outcomes at the time of the last follow-up, were collected and reviewed retrospectively.

Result(s): Treatments were successful in all 54 cases, 21 cases were treated with coiling and 33 cases with stent-assist coiling (SAC). The mean height of the aneurysm was 4.35 ± 1.9 mm, the mean width was 4.59 ± 1.9 mm, and the mean neck size was 3.63 ± 1.4 mm. Of the 54 cases, 50 (92.6%) cases were identified.

Conclusion(s): EVT for M1 hilltop aneurysms appears to be safe and efficacious, with low mid-term recurrence rate. However, long-term and large cohort study will be needed.

Publication History

Article published online:
09 February 2023