Endovascular treatment of giant or very large intracranial aneurysms with different modalities: an analysis of 20 cases.
BACKGROUND
The aim of this retrospective study was to evaluate the clinical efficacy and limitations of different endovascular modalities in the treatment of very large and giant intracranial aneurysms.


METHODS
A group of 20 patients with very large and giant intracranial aneurysms treated by endovascular approaches were retrospectively analyzed. Of the 20 patients, 9 had been treated by parent artery occlusion, 8 by coil embolization, and 3 with an intracranial covered stent. Two recurrent aneurysms initially treated with coil embolization were retreated with an intracranial covered stent. Patients were followed for 9-83 months after the procedure.


RESULTS
Endovascular treatment was technically feasible in all 20 patients. One patient died 7 days after the procedure from rebleeding caused by incomplete aneurysmal occlusion. Immediate postprocedural angiograms showed that complete occlusion was achieved in 11 aneurysms, subtotal occlusion in 7, and incomplete occlusion in 2. The final angiographic results in the other 19 surviving patients confirmed complete occlusion of 15 aneurysms, subtotal occlusion in 3, and incomplete occlusion in 1. Clinical evaluations performed at the final follow-up visit showed an excellent outcome in 11 patients and a good outcome in 8.


CONCLUSIONS
Endovascular treatment of giant intracranial aneurysms with coil embolization is often associated with a low complete occlusion rate and a high recanalization rate, and parent artery occlusion remains a practical option in selected patients. Based on our limited experience, the use of an intracranial covered stent appears to be a relatively simple and safe procedure for occluding very large and giant aneurysms while still maintaining the patency of the parent artery.
Li
Ming-Hua
MH
Department of Diagnostic and Interventional Radiology, The Sixth Affiliated People's Hospital, Shanghai Jiao Tong University, No. 600 Yi Shan Road, Shanghai, China.
Li
Yong-Dong
YD
Fang
Chun
C
Gu
Bing-Xian
BX
Cheng
Ying-Sheng
YS
Wang
Yong-Li
YL
Gao
Bu-Lang
BL
Zhao
Jun-Gong
JG
Wang
Ju
J
Li
Min
M
D000328:Adult; D017541:Aneurysm, False / Q000175:diagnosis / Q000628:therapy; D000800:Angioplasty, Balloon / Q000379:methods*; D002533:Cerebral Angiography; D020099:Coated Materials, Biocompatible; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012008:Recurrence; D015607:Stents; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
D020099:Coated Materials, Biocompatible