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J Neurointerv Surg. 2019 Jan;11(1):31-36. doi: 10.1136/neurintsurg-2018-013771. Epub 2018 Jun 1.

Wide-neck bifurcation aneurysms of the middle cerebral artery and basilar apex treated by endovascular techniques: a multicentre, core lab adjudicated study evaluating safety and durability of occlusion (BRANCH).

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Department of Neurosurgery, Mount Sinai Hospital, New York City, New York, USA.
Department of Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina, USA.
Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA.
Department of Neurosurgery, Albany Medical Center, Albany, New York, USA.
Department of Neurosurgery, Lyerly Baptist, Jacksonville, Florida, USA.
Department of Neurosurgery, UT Southwestern Medical Center, Dallas, Texas, USA.
Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Maryland, USA.
Neurointerventional Surgery, Northwestern Medicine at Central DuPage Hospital, Winfield, Illinois, USA.
Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA.



BRANCH (wide-neck bifurcation aneurysms of the middle cerebral artery and basilar apex treated by endovascular techniques) is a multicentre, retrospective study comparing core lab evaluation of angiographic outcomes with self-reported outcomes.


Consecutive patients were enrolled from 10 US centres, aged between 18 and 85 with unruptured wide-neck middle cerebral artery (MCA) or basilar apex aneurysms treated endovascularly. Patient demographics, aneurysm morphology, procedural information, mortality and morbidity data and core lab and self-reported modified Raymond Roy (RR) outcomes were obtained.


115 patients met inclusion criteria. Intervention-related mortality and significant morbidity rates were 1.7% (2/115) and 5.8% (6/103) respectively. Core lab adjudicated RR1 and 2 occlusion rates at follow-up were 30.6% and 32.4% respectively. The retreatment rate within the follow-up window was 10/115 (8.7%) and in stent stenosis at follow-up was 5/63 (7.9%). Self-reporting shows a statistically significant direction to angiographic RR one outcomes at follow-up compared with core lab evaluation, with OR 1.75 (95% CI 1.08 to 2.83).


Endovascular treatment of wide-neck MCA and basilar apex aneurysms resulted in a core lab adjudicated RR1 occlusion rate of 30.6%. Self-reported results at follow-up favour better angiographic outcomes, with OR 1.75 (95% CI 1.08 to 2.83). These data demonstrate the need for novel endovascular devices specifically designed to treat complex intracranial aneurysms, as well as the importance of core lab adjudication in assessing outcomes in such a trial.


aneurysm; balloon; coil; intervention; stent

Conflict of interest statement

Competing interests: AHS, ABP, RFJ are consultants for Medtronic Neurovascular. RFJ has received research funding from Medtronic Neuorvascular. BGW is a proctor for Medtronic Neurovascular.

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