Safety and efficacy of endovascular versus microsurgical treatment of unruptured wide-necked middle cerebral artery aneurysms: a propensity score–matched analysis of the NeuroVascular Quality Initiative Quality Outcomes Database Cerebral Aneurysm Registry

OBJECTIVE Unruptured, wide-necked middle cerebral artery (WN-MCA) aneurysms have traditionally been considered ideal candidates for microsurgery (MS), although endovascular treatment (EVT) has dramatically increased in popularity with the advent of novel devices such as intrasaccular flow disruptors. The purpose of this study was to evaluate the safety and efficacy of MS versus EVT for unruptured WN-MCA aneurysms.

METHODS The NeuroVascular Quality Initiative Quality Outcomes Database (NVQI-QOD) Cerebral Aneurysm Registry, a multiinstitutional, prospectively collected procedural database, was queried for cases of unruptured WN-MCA aneurysms treated with MS or EVT between 2015 and 2022. A wide neck was defined as an aneurysm neck ≥ 4 mm or a dome/neck ratio ≤ 2. Demographics and aneurysm characteristics were queried. Propensity score matching (PSM) was utilized to match aneurysm size, number of aneurysms treated, patient age, and aneurysm status. Safety outcomes were evaluated including intraoperative and postoperative complication rates. Aneurysm occlusion status and clinical outcomes using the modified Rankin Scale (mRS) score at discharge and the last follow-up were also assessed.

RESULTS Of 671 unruptured MCA aneurysms, 319 were wide necked. Thirty cases were excluded, as the aneurysm had been previously treated. Two hundred eighty-nine operations (203 EVT, 86 MS) in 282 patients satisfied inclusion criteria. After PSM, there were 86 operations in each group for analysis. The mean aneurysm width was 5.0 (EVT) versus 4.9 mm (MS; p = 0.285). Safety data showed similar intraoperative (7.0% EVT vs 3.5% MS, p = 0.496) and postoperative (4.7% vs 7%, p = 0.746) complication rates. The MS patients were more likely to have complete aneurysm occlusion at discharge (90.4% vs 58.8%, p < 0.001). In a limited subset of patients (52.9%) for whom outcome data were available, the EVT patients were more likely to have an mRS score 0 at discharge (50/59 [84.7%] vs 29/54 [53.7%], p < 0.0003] and at the last follow-up (36/55 [65.5%] vs 13/36 [36.1%], p = 0.006).

CONCLUSIONS This study describes a large, modern cohort of propensity score–matched patients who underwent treatment of unruptured WN-MCA aneurysms. Safety data on intraoperative and postoperative complication rates were similar in both treatment groups. MS was more likely to result in complete aneurysm occlusion at discharge. In a subset of patients with available outcome data, EVT was associated with better functional outcomes at discharge and the last followup. Given the lack of complete follow-up data and rates of retreatment, these results should be interpreted cautiously.

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Work Title Safety and efficacy of endovascular versus microsurgical treatment of unruptured wide-necked middle cerebral artery aneurysms: a propensity score–matched analysis of the NeuroVascular Quality Initiative Quality Outcomes Database Cerebral Aneurysm Registry
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Open Access
Creators
  1. Varun Padmanaban
  2. Junjia Zhu
  3. Shouhao Zhou
  4. Sameer A. Ansari
  5. Jay U. Howington
  6. Daniel H. Sahlein
  7. Juan G. Tejada
  8. D. Andrew Wilkinson
  9. Scott D. Simon
  10. Kevin M. Cockroft
  11. Ephraim W. Church
Keyword
  1. Cerebral aneurysm
  2. Middle cerebral artery aneurysm
  3. Endovascular therapy
  4. Microsurgery
  5. Wide-necked aneurysms
  6. Endovascular neurosurgery
  7. Vascular disorders
License In Copyright (Rights Reserved)
Work Type Article
Publisher
  1. Journal of Neurosurgery
Publication Date December 29, 2023
Publisher Identifier (DOI)
  1. https://doi.org/10.3171/2023.10.JNS231659
Deposited March 04, 2025

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  • Created

    March 04, 2025 16:44 by Researcher Metadata Database

  • Added Safety_and_efficacy_unruptured_wideneckedMCA.pdf

    March 04, 2025 16:44 by Researcher Metadata Database

  • Added Creator V Padmanaban

    March 04, 2025 16:44 by Researcher Metadata Database

  • Added Creator J Zhu

    March 04, 2025 16:44 by Researcher Metadata Database

  • Added Creator S Zhou

    March 04, 2025 16:44 by Researcher Metadata Database

  • Added Creator S A Ansari

    March 04, 2025 16:44 by Researcher Metadata Database

  • Added Creator J U Howington

    March 04, 2025 16:44 by Researcher Metadata Database

  • Added Creator D H Sahlein

    March 04, 2025 16:44 by Researcher Metadata Database

  • Added Creator J G Tejada

    March 04, 2025 16:44 by Researcher Metadata Database

  • Added Creator D Wilkinson

    March 04, 2025 16:44 by Researcher Metadata Database

  • Added Creator D. Andrew Wilkinson

    March 04, 2025 16:44 by Researcher Metadata Database

  • Added Creator Scott Simon

    March 04, 2025 16:44 by Researcher Metadata Database

  • Added Creator Kevin M. Cockroft

    March 04, 2025 16:44 by Researcher Metadata Database

  • Added Creator Ephraim W. Church

    March 04, 2025 16:44 by Researcher Metadata Database

  • Published

    March 04, 2025 16:44 by Researcher Metadata Database

  • Updated

    March 04, 2025 21:05 by [unknown user]

  • Updated Keyword, Description Show Changes

    March 05, 2025 11:31 by avs5190

    Keyword
    • Cerebral aneurysm, Middle cerebral artery aneurysm, Endovascular therapy, Microsurgery, Wide-necked aneurysms, Endovascular neurosurgery, Vascular disorders
    Description
    • OBJECTIVE Unruptured, wide-necked middle cerebral artery (WN-MCA) aneurysms have traditionally been considered ideal candidates for microsurgery (MS), although endovascular treatment (EVT) has dramatically increased in popularity with the advent of novel devices such as intrasaccular flow disruptors. The purpose of this study was to evaluate the safety and efficacy of MS versus EVT for unruptured WN-MCA aneurysms. METHODS The NeuroVascular Quality Initiative Quality Outcomes Database (NVQI-QOD) Cerebral Aneurysm Registry, a multiinstitutional, prospectively collected procedural database, was queried for cases of unruptured WN-MCA aneurysms treated with MS or EVT between 2015 and 2022. A wide neck was defined as an aneurysm neck ≥ 4 mm or a dome/neck ratio ≤ 2. Demographics and aneurysm characteristics were queried. Propensity score matching (PSM) was utilized to match aneurysm size, number of aneurysms treated, patient age, and aneurysm status. Safety outcomes were evaluated including intraoperative and postoperative complication rates. Aneurysm occlusion status and clinical outcomes using the modified Rankin Scale (mRS) score at discharge and the last follow-up were also assessed. RESULTS Of 671 unruptured MCA aneurysms, 319 were wide necked. Thirty cases were excluded, as the aneurysm had been previously treated. Two hundred eighty-nine operations (203 EVT, 86 MS) in 282 patients satisfied inclusion criteria. After PSM, there were 86 operations in each group for analysis. The mean aneurysm width was 5.0 (EVT) versus 4.9 mm (MS; p = 0.285). Safety data showed similar intraoperative (7.0% EVT vs 3.5% MS, p = 0.496) and postoperative (4.7% vs 7%, p = 0.746) complication rates. The MS patients were more likely to have complete aneurysm occlusion at discharge (90.4% vs 58.8%, p &lt; 0.001). In a limited subset of patients (52.9%) for whom outcome data were available, the EVT patients were more likely to have an mRS score 0 at discharge (50/59 [84.7%] vs 29/54 [53.7%], p &lt; 0.0003] and at the last follow-up (36/55 [65.5%] vs 13/36 [36.1%], p = 0.006). CONCLUSIONS This study describes a large, modern cohort of propensity score–matched patients who underwent treatment of unruptured WN-MCA aneurysms. Safety data on intraoperative and postoperative complication rates were similar in both treatment groups. MS was more likely to result in complete aneurysm occlusion at discharge. In a subset of patients with available outcome data, EVT was associated with better functional outcomes at discharge and the last followup. Given the lack of complete follow-up data and rates of retreatment, these results should be interpreted cautiously.
    • OBJECTIVE Unruptured, wide-necked middle cerebral artery (WN-MCA) aneurysms have traditionally been considered ideal candidates for microsurgery (MS), although endovascular treatment (EVT) has dramatically increased in popularity with the advent of novel devices such as intrasaccular flow disruptors. The purpose of this study was to evaluate the safety and efficacy of MS versus EVT for unruptured WN-MCA aneurysms.
    • METHODS The NeuroVascular Quality Initiative Quality Outcomes Database (NVQI-QOD) Cerebral Aneurysm Registry, a multiinstitutional, prospectively collected procedural database, was queried for cases of unruptured WN-MCA aneurysms treated with MS or EVT between 2015 and 2022. A wide neck was defined as an aneurysm neck ≥ 4 mm or a dome/neck ratio ≤ 2. Demographics and aneurysm characteristics were queried. Propensity score matching (PSM) was utilized to match aneurysm size, number of aneurysms treated, patient age, and aneurysm status. Safety outcomes were evaluated including intraoperative and postoperative complication rates. Aneurysm occlusion status and clinical outcomes using the modified Rankin Scale (mRS) score at discharge and the last follow-up were also assessed.
    • RESULTS Of 671 unruptured MCA aneurysms, 319 were wide necked. Thirty cases were excluded, as the aneurysm had been previously treated. Two hundred eighty-nine operations (203 EVT, 86 MS) in 282 patients satisfied inclusion criteria. After PSM, there were 86 operations in each group for analysis. The mean aneurysm width was 5.0 (EVT) versus 4.9 mm (MS; p = 0.285). Safety data showed similar intraoperative (7.0% EVT vs 3.5% MS, p = 0.496) and postoperative (4.7% vs 7%, p = 0.746) complication rates. The MS patients were more likely to have complete aneurysm occlusion at discharge (90.4% vs 58.8%, p &lt; 0.001). In a limited subset of patients (52.9%) for whom outcome data were available, the EVT patients were more likely to have an mRS score 0 at discharge (50/59 [84.7%] vs 29/54 [53.7%], p &lt; 0.0003] and at the last follow-up (36/55 [65.5%] vs 13/36 [36.1%], p = 0.006).
    • CONCLUSIONS This study describes a large, modern cohort of propensity score–matched patients who underwent treatment of unruptured WN-MCA aneurysms. Safety data on intraoperative and postoperative complication rates were similar in both treatment groups. MS was more likely to result in complete aneurysm occlusion at discharge. In a subset of patients with available outcome data, EVT was associated with better functional outcomes at discharge and the last followup. Given the lack of complete follow-up data and rates of retreatment, these results should be interpreted cautiously.
  • Deleted Creator D Wilkinson

    March 05, 2025 11:33 by avs5190

  • Renamed Creator Varun Padmanaban Show Changes

    March 05, 2025 11:33 by avs5190

    • V Padmanaban
    • Varun Padmanaban
  • Renamed Creator Junjia Zhu Show Changes

    March 05, 2025 11:33 by avs5190

    • J Zhu
    • Junjia Zhu
  • Renamed Creator Shouhao Zhou Show Changes

    March 05, 2025 11:33 by avs5190

    • S Zhou
    • Shouhao Zhou
  • Renamed Creator Sameer A. Ansari Show Changes

    March 05, 2025 11:33 by avs5190

    • S A Ansari
    • Sameer A. Ansari
  • Renamed Creator Jay U. Howington Show Changes

    March 05, 2025 11:33 by avs5190

    • J U Howington
    • Jay U. Howington
  • Renamed Creator Daniel H. Sahlein Show Changes

    March 05, 2025 11:33 by avs5190

    • D H Sahlein
    • Daniel H. Sahlein
  • Renamed Creator Juan G. Tejada Show Changes

    March 05, 2025 11:33 by avs5190

    • J G Tejada
    • Juan G. Tejada
  • Updated Creator D. Andrew Wilkinson

    March 05, 2025 11:33 by avs5190

  • Renamed Creator Scott D. Simon Show Changes

    March 05, 2025 11:33 by avs5190

    • Scott Simon
    • Scott D. Simon
  • Updated Creator Kevin M. Cockroft

    March 05, 2025 11:33 by avs5190

  • Updated Creator Ephraim W. Church

    March 05, 2025 11:33 by avs5190