Management of wide neck unruptured aneurysms in the middle cerebral artery with flow diverter stents: early and mid-term outcomes

OpenAlex · English

Objective The primary aim of this study is to analyze the efficacy of flow diverter stent (FDS) treatment in complex middle cerebral artery (MCA) aneurysms and to identify the predictors of clinical success based on mid-term outcomes. Materials and Methods We retrospectively reviewed the medical records of patients with wide-necked and/or side-branch-incorporating MCA aneurysms treated with FDS between January 1, 2022, and May 1, 2025. Aneurysm localization and dimensions were documented. The presence of branches covered by the stent or originating from the aneurysm sac was recorded. Follow-up imaging at 2, 5, and 12 months was analyzed for aneurysm filling, FDS patency, and integrated/jailed branch patency. Results A total of 44 MCA aneurysms were included in the study. The overall treatment success rate at the 12-month follow-up was 93.18%. The mean follow-up duration for the entire cohort was 22 ± 9 months. Although caliber reduction was observed in 71% of the 14 MCA branches covered by the FDS during follow-up, no adverse clinical findings or complications were noted. At the 12-month follow-up, significant statistical differences were found between OKM categories regarding aneurysm height, mediolateral width, and neck diameter ( p = 0.029, p = 0.006, and p = 0.011, respectively). Furthermore, at the 5-month follow-up, a significant correlation was identified between OKM classification and the presence of a branch originating from the aneurysm ( p = 0.004; Cramer's V = 0.497). Conclusion FDS treatment provides a safe and effective therapeutic alternative to conventional methods for complex MCA aneurysms, ensuring high occlusion rates while maintaining the patency of associated vascular branches.