Trial Parameters
Brief Summary
Intracranial aneurysms located on the middle cerebral artery (MCA) are considered by many surgeons to represent a distinct subgroup of aneurysms for which clipping may still be the best management option. Most MCA aneurysms are accessible, proximal control can readily be secured in case of rupture, and clip application can typically proceed without requiring the dissection of perforating arteries. In comparison, certain anatomic features of MCA aneurysms such as a wide neck, often including a branch artery origin, frequently render endovascular management more difficult. New endovascular devices were and continue to be introduced to address these anatomic difficulties, including stents, flow diverters, and intra-saccular flow disruptors (ISFDs) such as the WEB. Thus, while most aneurysms are increasingly treated with endovascular methods, many MCA aneurysm patients are still managed surgically, but convincing evidence of which management paradigm is best is lacking.
Eligibility Criteria
Inclusion Criteria: * Patients at least 18 years of age * At least one documented, intradural, intracranial aneurysm anywhere on the course of the MCA vessel, ruptured or unruptured. An untreated ruptured aneurysm (with delay in diagnosis) which is suspected to have occurred more than 30 days prior to study inclusion will be considered an unruptured aneurysm * In the case of SAH, WFNS grade 4 or less * The patient and aneurysm are considered appropriate for either surgical or endovascular treatment by the treating team Exclusion Criteria: * Patients with absolute contraindications administration of contrast material (any type) * Patients with AVM-associated aneurysms * Patients or caregivers unable to provide consent * Poor grade (WFNS 5) ruptured aneurysms