title: Innovations in Endovascular Treatment Strategies for Large Carotid Cavernous Aneurysms-The Safety and Efficacy of a Flow Diverter.
abstract: BACKGROUND
  The efficacy for the treatment of large carotid cavernous aneurysms (CCAs) was compared between conventional endovascular treatments, stent-assisted coiling (SAC), parent artery occlusion (PAO), and the flow diverter (FD).
  
  
  METHODS
  Between January 2001 and December 2015, 49 patients with large, broad-necked, unruptured CCA underwent endovascular treatment at our institution. We performed PAO in 22 patients, SAC in 18 patients, and FD in 9 patients. Safety and efficacy were assessed in all patients by periodic clinical and radiological examinations during a 6-month follow-up.
  
  
  RESULTS
  All 22 aneurysms treated with PAO disappeared immediately after treatment, but in the SAC-treated group, complete occlusion was obtained in only 5 of the 18 patients. All aneurysms in the FD group resulted in body filling. Perioperative ipsilateral temporary ischemic events occurred in 6 cases (PAO 4, SAC 2, FD 0). Delayed deterioration or new onset of cranial nerve symptoms was observed in 10 cases (PAO 3, SAC 3, FD 4), almost all of which recovered within 3 months. During the 6-month follow-up, all aneurysms treated with PAO showed a decrease in size without recanalization. In the SAC group, 12 aneurysms showed neck remnants, and marked recanalization occurred in 4 cases. Six of the 9 aneurysms in the FD group were completely occluded.
  
  
  CONCLUSIONS
  The FD provided excellent final results despite transient worsening of symptoms. Although further long-term follow-up is essential, from a cost-effective and time-saving viewpoint, FD is a relatively safe and reliable method for the treatment of large CCAs.
authors.affiliation: Department of Neurosurgery and Endovascular Therapy, Osaka Medical College, Osaka, Japan. Electronic address: neu137@poh.osaka-med.ac.jp.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Miyachi
authors.affiliation: Department of Neurosurgery and Endovascular Therapy, Osaka Medical College, Osaka, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ohnishi
authors.affiliation: Department of Neurosurgery and Endovascular Therapy, Osaka Medical College, Osaka, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Hiramatsu
authors.affiliation: Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Izumi
authors.affiliation: Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Matsubara
authors.affiliation: Department of Neurosurgery and Endovascular Therapy, Osaka Medical College, Osaka, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Kuroiwa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D002533:Cerebral Angiography / Q000379:methods; D000072226:Computed Tomography Angiography; D016208:Databases, Factual; D004059:Diffusion of Innovation; D004185:Disability Evaluation; D004621:Embolization, Therapeutic / Q000009:adverse effects; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D007564:Japan; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012039:Regional Blood Flow; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: Carotid cavernous aneurysm; complication; flow diverter; parent artery occlusion; stent-assisted coiling