title: Endovascular embolization is applicable for large and giant intracranial aneurysms: experience in one center with long-term angiographic follow-up.
abstract: BACKGROUND
  Endovascular treatment of large and giant intracranial aneurysms and long-term results of angiographic follow-up of these aneurysms treated endovascularly are not known currently.
  
  
  OBJECTIVE
  To investigate the outcome of endovascular treatment of large and giant aneurysms and the long-term angiographic follow-up results.
  
  
  METHODS
  A retrospective analysis of all patients with endovascular treatment of large and giant aneurysms between 1998 and 2009 was performed. There were 90 large or giant aneurysms treated with coiling alone, stent-assisted coiling, covered-stent deployment, or parent artery occlusion (PAO) in 88 patients (female/male, 54/34; age range, 23-92 years; mean age, 56 years).
  
  
  RESULTS
  Immediately after the initial endovascular embolization procedure, complete occlusion was achieved in 56.7%, near complete occlusion in 37.8%, and incomplete occlusion in 5.5%. The total periprocedural complication rate excluding subarachnoid hemorrhage (SAH)-induced vasospasm was 10.2% with a mortality rate of 2.3%. Follow-up angiography was performed in all of the aneurysms with the longest follow-up duration of 131 months. Among 38 aneurysms initially treated with coiling alone and 17 initially treated with stent-assisted coiling, 22 (57.9%) and four (23.5%) recurred, respectively, during follow-up. No recurrence occurred in aneurysms initially treated with covered-stent deployment or PAO. Aneurysm recurrence was predominantly seen in older and female patients, in larger aneurysms, and in aneurysms treated with coiling alone. Twenty-three aneurysms were successfully retreated endovascularly.
  
  
  CONCLUSIONS
  Endovascular intervention with coiling alone or stent-assisted coiling for large and giant cerebral aneurysms is not very effective, while covered stents are more promising. Better endovascular devices are needed to obtain more secure closure.
authors: Department of Neurology, Henan Provincial People's Hospital, PR China.
authors: Bing
authors: B
authors: Wang
authors: Department of Neurosurgery, First Hospital of Shijiazhuang and People's Hospital, Hebei Medical University, PR China Shanghai Sixth Hospital, Shanghai Jiaotong University, PR China browngao@yeah.net.
authors: Bu-Lang
authors: BL
authors: Gao
authors: Department of Pathology, Dali University College of Basic Medicine, PR China.
authors: Guo-Ping
authors: GP
authors: Xu
authors: Department of Neurosurgery, First Hospital of Shijiazhuang and People's Hospital, Hebei Medical University, PR China.
authors: Cheng
authors: C
authors: Xiang
authors: Department of Radiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, PR China.
authors: Xiao-Sheng
authors: XS
authors: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis; D002533:Cerebral Angiography; D054855:Drug-Eluting Stents; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Intracranial aneurysms; angiography; endovascular treatment; large and giant; long-term follow-up