Etminan et al. (1) offer a very instructive and clear presentation of the risk factors for aneurysm rupture in their review of unruptured intracranial aneurysms, and they clearly describe the often complex counseling of patients about the various treatment options (1). For aneurysms of the middle cerebral artery (MCA), they recommend microsurgical clipping as a primary therapy because of the lower risk of recurrence (1). It is certainly correct that MCA aneurysms are treated by clipping more often than average at many centers, due to their relatively easier surgical access as compared to other locations. Nevertheless, the current data and meta-analyses, as well as our own experience (2, 3), show that unruptured MCA aneurysms can be treated using modern endovascular techniques with comparable morbidity and mortality. Therefore, the therapeutic approach for this location should also be discussed in an interdisciplinary and open-ended manner in accordance with the individual expertise of the treating specialist in the respective center, taking into account current literature. From our point of view, a general “clip-first policy” based on location is no longer appropriate for MCA aneurysms.
Footnotes
Conflict of interest statement
Prof. Berlis has received consultant honoraria from Microvention, Stryker, and Medtronic.
Prof. Weber has received consultant honoraria, reimbursement of travel expenses and meeting participation fees, and speaking honoraria from Medtronic, Stryker, Phenox, Penumbra, and Microvention.
PD Dr. Fischer has received consultant honoraria from Microvention, Kaneka Pharma, and Stryker Neurovascular, study support (third-party funds) from Kaneka Pharma, and reimbursement of travel expense reimbursement and speaking honoraria from Microvention, Stryker Neurovascular, and Rapid Medical.
Dr. Maurer declares that no conflict of interests exists.
References
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