title: Therapeutic Internal Carotid Artery Occlusion for Large and Giant Aneurysms: A Single Center Cohort of 146 Patients.
abstract: OBJECTIVE
  At our institution, patients with large or giant ICA aneurysms are preferably treated with endovascular ICA balloon occlusion. Alternative treatment or conservative treatment is offered only for patients who cannot tolerate permanent ICA occlusion. In this observational study, we report the clinical and imaging results of ICA occlusion for aneurysms in a large single-center patient cohort.
  
  
  METHODS
  Between January 1995 and January 2015, occlusion of the ICA was considered in 146 patients with large or giant ICA aneurysms. Ninety-six patients (66%) passed the angiographic test occlusion, and, in 88 of these 96 patients (92%), the ICA was permanently occluded. In 11 of 88 patients with angiographic tolerance, ICA occlusion was performed with the patient under general anesthesia without clinical testing.
  
  
  RESULTS
  There was 1 hypoperfusion infarction after hypovolemic shock from a large retroperitoneal hematoma (complication rate 1.1% [95% CI, 1%-6.8%]). The mean imaging and clinical follow-up was 35 months (median 18 months; range, 3-180 months). On the latest MR imaging, 87 of 88 aneurysms (99%) were completely occluded and 61 of 80 aneurysms (76%) were decreased in size or completely obliterated. Of 62 patients who presented with cranial nerve dysfunction by mass effect of the aneurysm, 30 (48%) were cured, 25 (40%) improved, 6 (10%) were unchanged, and 1 patient (2%) was hemiplegic after a complication.
  
  
  CONCLUSIONS
  ICA occlusion for large and giant aneurysms after angiographic test occlusion was safe and effective. Two-thirds of eligible patients passed the angiographic test. Most aneurysms shrunk, and most cranial nerve dysfunctions were cured or improved.
authors: From Sint Elisabeth Ziekenhuis (R.S.B., J.P.P., M.S., W.J.v.R.), Tilburg, the Netherlands.
authors: R S
authors: http://orcid.org/0000-0002-8674-6326
authors: RS
authors: Bechan
authors: Academisch Medisch Centrum (C.B.M., M.E.S.), Amsterdam, the Netherlands.
authors: C B
authors: http://orcid.org/0000-0002-7600-9568
authors: CB
authors: Majoie
authors: Academisch Medisch Centrum (C.B.M., M.E.S.), Amsterdam, the Netherlands.
authors: M E
authors: http://orcid.org/0000-0001-6895-1353
authors: ME
authors: Sprengers
authors: From Sint Elisabeth Ziekenhuis (R.S.B., J.P.P., M.S., W.J.v.R.), Tilburg, the Netherlands.
authors: J P
authors: http://orcid.org/0000-0002-5957-9091
authors: JP
authors: Peluso
authors: From Sint Elisabeth Ziekenhuis (R.S.B., J.P.P., M.S., W.J.v.R.), Tilburg, the Netherlands.
authors: M
authors: http://orcid.org/0000-0002-3949-5958
authors: M
authors: Sluzewski
authors: From Sint Elisabeth Ziekenhuis (R.S.B., J.P.P., M.S., W.J.v.R.), Tilburg, the Netherlands wjjvanrooij@gmail.com.
authors: W J
authors: http://orcid.org/0000-0001-5931-1186
authors: WJ
authors: van Rooij
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion / Q000295:instrumentation / Q000379:methods*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy; D055815:Young Adult