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)

Reade A. De Leacy, Kyle M. Fargen, Justin R. Mascitelli, Johanna Fifi, Lena Turkheimer, Xiangnan Zhang, Aman B. Patel, Matthew J. Koch, Aditya S. Pandey, D. Andrew Wilkinson, Julius Griauzde, Robert F. James, Enzo M. Fortuny, Aurora Cruz, Alan Boulos, Emad Nourollah-Zadeh, Alexandra Paul, Eric Sauvageau, Ricardo Hanel, Pedro Aguilar-SalinasRoberta Novakovic, Babu G Welch, Ranyah Almardawi, Gaurav Jindal, Harish Shownkeen, Elad I. Levy, Adnan H. Siddiqui, J. Mocco

Research output: Contribution to journalArticle

9 Scopus citations


Background and purpose 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. Materials and methods 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. Results 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). Conclusion 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.

Original languageEnglish (US)
Pages (from-to)31-36
Number of pages6
JournalJournal of NeuroInterventional Surgery
Issue number1
Publication statusPublished - Jan 1 2019



  • aneurysm
  • balloon
  • coil
  • intervention
  • stent

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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