title: Endovascular management of giant intracranial aneurysms of the posterior circulation.
abstract: BACKGROUND
  Large size, and location in posterior circulation, both individually portend high risk in the endovascular management of intracranial aneurysms.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the outcome of endovascular management of giant posterior circulation aneurysms at our centre.
  
  
  METHODS
  This is a retrospective analysis of 22 consecutive patients with giant posterior circulation aneurysms, who were managed by endovascular techniques between 1997 and 2009. The aneurysms included: Vertebral-6 (27%), basilar or vertebrobasilar - 7 (32%) and nine posterior cerebral artery (PCA) - 9 (41%).
  
  
  RESULTS
  There were 14 males and eight females with a mean age of 37 years. Treatment modalities included: Parent vessel sacrifice (PVS), coil embolization, flow reversal, stent-assisted coiling, and telescopic stent placement. Angiographic cure or stasis was achieved in 21 (95%) patients and no recurrence was observed in 17 of the 18 patients who had follow-up. Complications occurred in 9 (41%) patients, death in 4 and morbidity in 5 (3 with good eventual outcome). Overall, good clinical outcome was noted in 16 (73%) patients. The majority of the poor outcomes were observed in the management of basilar/vertebrobasilar aneurysms and flow reversal. Parent vessel sacrifice showed the best outcomes with stable results.
  
  
  CONCLUSIONS
  Our results suggest that PVS remains the procedure of choice wherever possible and is relatively safe, particularly for giant vertebral and PCA aneurysms. When PVS is not feasible, stent-assisted coiling is a reasonable and safe option and requires follow-up. Management of basilar or vertebrobasilar aneurysms is complicated and still evolving.
authors.affiliation: Department of Interventional Neuroradiology, Seth GS Medical College and KEM Hospital, Parel, Mumbai, India. kem_inr@yahoo.co.in
authors.forename: Uday S
authors.initials: US
authors.lastname: Limaye
authors.forename: Akshay
authors.initials: A
authors.lastname: Baheti
authors.forename: Rashmi
authors.initials: R
authors.lastname: Saraf
authors.forename: Manish
authors.initials: M
authors.lastname: Shrivastava
authors.forename: W
authors.initials: W
authors.lastname: Siddhartha
mesh_terms: D000293:Adolescent; D000328:Adult; D001807:Blood Vessel Prosthesis; D002533:Cerebral Angiography; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020769:Posterior Cerebral Artery / Q000473:pathology / Q000503:physiopathology; D011446:Prospective Studies; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult