• Flow diverter in the treatment of MCA aneurysms:

In this episode we begin to discuss the risk of complications when using FD in the MCA bifurcation. Data in the literature, although old (2017), show a complication rate of around 20% and morbidity of 10% in this type of case.7. Most recent data from 2022 shows a morbidity rate of 8.6% and mortality of 2%. Another study from 2022 demonstrated a complete aneurysm occlusion rate of 80% and a thromboembolic complication rate of 16.7%.

An important point raised by Pr. Adnan Siddiqui is that we must be cautious when analyzing these papers as the aneurysms treated are more complex and often not possible with other techniques such as the SLICE 2024 MCA aneurysm and the complications should be higher. Another discussion was about the reproducibility of the technique and there was a reproducibility rate of approximately 7.9. Furthermore, we discuss the durability of the treatment, which is approximately 9.5.

At the end of the episode, Pr. Vincent Costalat demonstrated a similar case of MCA bifurcation aneurysm recanalized after treatment with coils. The same strategy of using FD covering a branch of the MCA was carried out and, although the patient was tested for antiaggregation with good results, he had ischemia in the branch covered by the FD 9 days after treatment. Pr. Costalat raised the discussion that perhaps this strategy should not be the first one in these cases.

• Further reading:

1) Piano, M. et al. Flow diverter devices in the treatment of complex middle cerebral artery aneurysms when surgical and endovascular treatments are challenging. J. Stroke Cerebrovasc. Dis. 31, 106760 (2022)

2) BhogalP,AlMatterM,Ba ̈ znerH,etal.Flowdiversionforthetreat- ment of MCA bifurcation aneurysms: a single centre experience. Front Neurol 2017;8:20 CrossRef Medline