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Peer-reviewedCC BY 4.0Frontiers in Neurology

Efficacy and safety of flow diverters for middle cerebral artery bifurcation aneurysms: a retrospective dual-center study

  • Liu-tong Zhang1,2
  • Ying-hao Yang1
  • Shu-juan Zuo1,2
  • Peng-chao Zhan1
  • Qing-liang Chen1
  • Zhao-jun Li1
  • Meng Shen1
  • Hao Liang1
  • Ming Zheng1
  • Jun-hua Li1
  • Wen-le Fu1,2
  • Ji Ma3
1 more authors
  • Teng-fei Li3
  1. 1Department of Interventional Radiology, The Third People’s Hospital of Henan Province
  2. 2Collaborative Innovation Center of Prevention and Treatment of Major Diseases by Chinese and Western Medicine
  3. 3Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University
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Abstract

Purpose: To evaluate the efficacy and safety of flow diverters (FDs) for the treatment of middle cerebral artery (MCA) bifurcation aneurysms.

Methods: This retrospective, dual-center study enrolled 29 patients with unruptured MCA bifurcation aneurysms treated with flow diverters (FDs) between January 2021 and December 2024. Clinical outcomes were assessed using the modified Rankin Scale (mRS), where scores of 0–2 indicated a favorable functional outcome. Aneurysm occlusion was evaluated at the 6-month follow-up using the O’Kelly-Marotta (OKM) grading scale on digital subtraction angiography (DSA). Procedure-related complications, including in-stent stenosis (ISS), were systematically recorded.

Results: All 29 aneurysms were successfully treated with FD, with no technical failures, in-stent thrombosis, cerebral hemorrhage, or ischemic events observed during the perioperative period. No patients developed new neurological deficits before discharge. All patients were followed up via telephone and outpatient visits after discharge. Six-month angiographic follow-up was performed in all 29 patients by DSA. The follow-up duration ranged from 6 to 43.2 months. At the final follow-up, one patient developed vertigo and a transient episode of left limb weakness more than 2 months after treatment. The mRS score was 0 in 28 patients and 1 in one patient. The 6-month angiographic outcomes were: OKM Grade A in 1 patient (3.4%), Grade B in 5 (17.3%), Grade C in 7 (24.1%), and Grade D in 16 (55.2%). ISS was observed in 3 patients (10.3%): one moderate proximal, one moderate mid-stent, and one diffuse severe stenosis. The overall procedure-related complication rate was 3.4% (1/29), with a mortality rate of 0%. The probability of achieving complete occlusion was >88.8% for necks ≤ 3.0 mm, compared to >53.3% for necks between 3.0–5.0 mm.

Conclusion: Our findings suggest that the use of FDs is an effective and safe therapeutic option for MCA bifurcation aneurysms. A neck diameter ≤ 5.0 mm was associated with a higher likelihood of complete occlusion; this association requires external validation.

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Cite

BibTeXRIS
BibTeX
@article{zhang2026efficacy,
  title = {{Efficacy and safety of flow diverters for middle cerebral artery bifurcation aneurysms: a retrospective dual-center study}},
  author = {Liu-tong Zhang and Ying-hao Yang and Shu-juan Zuo and Peng-chao Zhan and Qing-liang Chen and Zhao-jun Li and Meng Shen and Hao Liang and Ming Zheng and Jun-hua Li and Wen-le Fu and Ji Ma and Teng-fei Li},
  journal = {Frontiers in Neurology},
  year = {2026},
  month = nov,
  doi = {10.3389/fneur.2026.1979215},
  url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1979215/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Efficacy and safety of flow diverters for middle cerebral artery bifurcation aneurysms: a retrospective dual-center study
AU  - Liu-tong Zhang
AU  - Ying-hao Yang
AU  - Shu-juan Zuo
AU  - Peng-chao Zhan
AU  - Qing-liang Chen
AU  - Zhao-jun Li
AU  - Meng Shen
AU  - Hao Liang
AU  - Ming Zheng
AU  - Jun-hua Li
AU  - Wen-le Fu
AU  - Ji Ma
AU  - Teng-fei Li
PY  - 2026
DA  - 2026/11/03
JO  - Frontiers in Neurology
DO  - 10.3389/fneur.2026.1979215
UR  - https://www.frontiersin.org/articles/10.3389/fneur.2026.1979215/full
AB  - Purpose: To evaluate the efficacy and safety of flow diverters (FDs) for the treatment of middle cerebral artery (MCA) bifurcation aneurysms.  Methods: This retrospective, dual-center study enrolled 29 patients with unruptured MCA bifurcation aneurysms treated with flow diverters (FDs) between January 2021 and December 2024. Clinical outcomes were assessed using the modified Rankin Scale (mRS), where scores of 0–2 indicated a favorable functional outcome. Aneurysm occlusion was evaluated at the 6-month follow-up using the O’Kelly-Marotta (OKM) grading scale on digital subtraction angiography (DSA). Procedure-related complications, including in-stent stenosis (ISS), were systematically recorded.  Results: All 29 aneurysms were successfully treated with FD, with no technical failures, in-stent thrombosis, cerebral hemorrhage, or ischemic events observed during the perioperative period. No patients developed new neurological deficits before discharge. All patients were followed up via telephone and outpatient visits after discharge. Six-month angiographic follow-up was performed in all 29 patients by DSA. The follow-up duration ranged from 6 to 43.2 months. At the final follow-up, one patient developed vertigo and a transient episode of left limb weakness more than 2 months after treatment. The mRS score was 0 in 28 patients and 1 in one patient. The 6-month angiographic outcomes were: OKM Grade A in 1 patient (3.4%), Grade B in 5 (17.3%), Grade C in 7 (24.1%), and Grade D in 16 (55.2%). ISS was observed in 3 patients (10.3%): one moderate proximal, one moderate mid-stent, and one diffuse severe stenosis. The overall procedure-related complication rate was 3.4% (1/29), with a mortality rate of 0%. The probability of achieving complete occlusion was >88.8% for necks ≤ 3.0 mm, compared to >53.3% for necks between 3.0–5.0 mm.  Conclusion: Our findings suggest that the use of FDs is an effective and safe therapeutic option for MCA bifurcation aneurysms. A neck diameter ≤ 5.0 mm was associated with a higher likelihood of complete occlusion; this association requires external validation.
SN  - 1664-2295
ER  -