Endovascular treatment of giant and large intracranial aneurysms by using a combination of stent placement and liquid polymer injection.
OBJECTIVE
The aim of this study was to test the feasibility, safety, and efficacy of a new endovascular method for the treatment of giant intracranial aneurysms. This new method consists of combining a metallic stent with a liquid polymer; the stent is first placed across the neck of the aneurysm to reconstruct a tubular arterial lumen, followed by obliteration of the fundus of the aneurysm with an ethyl vinyl alcohol polymer. During its injection, the liquid polymer is contained within the aneurysm by temporarily inflating an occlusion balloon in the parent artery.


METHODS
Eleven patients harboring a giant aneurysm were successfully treated using this procedure. All aneurysms were excluded from the circulation, with preservation of the parent artery. In nine of the 11 patients, the 6-month follow-up angiogram demonstrated no recanalization of the aneurysm. In one patient who had a giant and partially clotted internal carotid artery bifurcation aneurysm, the follow-up angiogram demonstrated minimal recanalization. The complications in this series of patients included one death and one case of transient hemiparesis caused by watershed ischemia.


CONCLUSIONS
The initial anatomical results and the clinical outcome in this small series of patients are very encouraging. The mortality and morbidity rates associated with this new endovascular treatment are superior to those associated with surgical clipping of giant aneurysms.
Mawad
Michel E
ME
The Methodist Hospital-Baylor College of Medicine, Houston, Texas 77030, USA. mmawad@tmh.tmc.edu
Cekirge
Saruhan
S
Ciceri
Elisa
E
Saatci
Isil
I
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D002426:Cavernous Sinus / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D002648:Child; D004121:Dimethyl Sulfoxide / Q000008:administration & dosage; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011108:Polymers / Q000008:administration & dosage*; D011145:Polyvinyls / Q000008:administration & dosage; D015607:Stents; D016896:Treatment Outcome
C450660:Onyx copolymer; D011108:Polymers; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide