title: Endovascular treatment of the distal internal carotid artery large aneurysm.
abstract: OBJECTIVE
  According to the development of endovascular technique and devices, larger aneurysms on the distal internal carotid artery (ICA) can be treated using a less invasive method. The authors report on clinical and angiographic outcomes of these aneurysms treated using an endovascular technique.
  
  
  METHODS
  Data on 21 patients with large aneurysms at distal ICA treated by endovascular method between January 2005 and December 2012 were included in this retrospective analysis.
  
  
  RESULTS
  Clinical outcome of patients showed strong correlation with the initial neurologic status (p < 0.05). Aneurysm morphology showed saccular, fusiform, and wide-neck in 12, six and three patients. Six patients underwent stent assisted coiling and the other 15 patients underwent simple coiling. Aneurysm occlusion was performed immediately after embolization with near-complete (Raymond class 1-2) in 20 patients (95.2%) and incomplete (Raymond class 3) in one patient (4.8%). Delayed thrombotic occlusion occurred in two patients and their clinical result was fatal. Another five patients died in the hospital, from massive brain edema and/or increased intracranial pressure due to initial subarachnoid hemorrhage. Overall mortality was 30% (seven out of 21). Fatal complication related to the endovascular procedure occurred in two patients with thrombosis at middle cerebral artery (one with stent, the other without it).
  
  
  CONCLUSIONS
  Recent developed endovascular device and technique is safe enough and a less invasive method for distal large or giant aneurysms. Based on our analysis of the study, we suspect that coil embolization of large distal ICA aneurysms (with or without stenting) is effective and safe.
authors.affiliation: Department of Neurosurgery, Uijongbu St. Mary's Hospital, School of Medicine, The Catholic University, Uijongbu, Korea.
authors.forename: Hong-Ju
authors.initials: HJ
authors.lastname: Bae
authors.affiliation: Department of Neurosurgery, Uijongbu St. Mary's Hospital, School of Medicine, The Catholic University, Uijongbu, Korea.
authors.forename: Do-Sung
authors.identifier: 0000-0003-2569-6502
authors.initials: DS
authors.lastname: Yoo
authors.affiliation: Department of Neurosurgery, Uijongbu St. Mary's Hospital, School of Medicine, The Catholic University, Uijongbu, Korea.
authors.forename: Pil-Woo
authors.initials: PW
authors.lastname: Huh
authors.affiliation: Department of Neurosurgery, Uijongbu St. Mary's Hospital, School of Medicine, The Catholic University, Uijongbu, Korea.
authors.forename: Tae-Gyu
authors.initials: TG
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Uijongbu St. Mary's Hospital, School of Medicine, The Catholic University, Uijongbu, Korea.
authors.forename: Kyoung-Suok
authors.initials: KS
authors.lastname: Cho
authors.affiliation: Department of Neurosurgery, Uijongbu St. Mary's Hospital, School of Medicine, The Catholic University, Uijongbu, Korea.
authors.forename: Sang-Bok
authors.initials: SB
authors.lastname: Lee
keywords: Endovascular; Internal carotid artery; Large aneurysm; Stent