Clinical Outcomes of Endovascular Coil Embolization for Ruptured Middle Cerebral Artery Aneurysms

Objective: Middle cerebral artery (MCA) aneurysms are difficult to treat with coil embolization (CE) due to their location and shape, but the number of CE-treated MCA has gradually increased as treatment techniques have improved. However, the outcomes of CE for ruptured MCA aneurysms are poorly understood. This study aimed to evaluate the outcomes of CE for ruptured MCA aneurysms.Methods: We retrospectively analyzed the medical records of patients with aneurysmal subarachnoid hemorrhages (aSAH) that were treated with CE between 2013 and 2020, and compared the differences in outcomes depending on aneurysm location.Results: A total of 468 patients with aSAH were included: 39 patients had ruptured MCA aneurysms (group M), and 429 had ruptured aneurysms at other sites (group O). There were no significant differences between the background characteristics of the 2 groups. Also, there were no significant intergroup differences in occlusion status, the frequency of complications such as ischemia, hemorrhaging, rebleeding, retreatment, or the modified Rankin Scale score at discharge. However, intracerebral hemorrhage (ICH) removal was required significantly more frequently in group M than in group O (10.3% vs. 0.5%, p = 0.0006). By case-matching analysis, there were no significant differences in these outcomes. All MCA cases that needed removal had more than 36 ml of hematoma volume. Logistic regression analysis showed that the existence of ICH at onset was a poor prognostic factor for ruptured MCA aneurysms.Conclusion: CE for ruptured MCA aneurysms produced acceptable outcomes in selected cases. However, the indications for CE in patients with ICH should be carefully considered.