Endovascular treatment of giant or very large intracranial aneurysms with different modalities: an analysis of 20 cases.

Authors:
Ming-Hua Li
Ming-Hua Li
The Sixth Affiliated People's Hospital
China
Yong-Dong Li
Yong-Dong Li
Shanghai Jiao Tong University
China
Chun Fang
Chun Fang
Shanghai Jiao Tong University
China
Bing-Xian Gu
Bing-Xian Gu
Key Laboratory of Dairy Science
Ying-Sheng Cheng
Ying-Sheng Cheng
The Sixth Affiliated People's Hospital
China
Yong-Li Wang
Yong-Li Wang
Institute of Metal Research
Jun-Gong Zhao
Jun-Gong Zhao
The Sixth Affiliated People's Hospital
China

Neuroradiology 2007 Oct 5;49(10):819-28. Epub 2007 Jul 5.

Department of Diagnostic and Interventional Radiology, The Sixth Affiliated People's Hospital, Shanghai Jiao Tong University, No. 600 Yi Shan Road, Shanghai, China.

Introduction: The aim of this retrospective study was to evaluate the clinical efficacy and limitations of different endovascular modalities in the treatment of very large and giant intracranial aneurysms.

Methods: A group of 20 patients with very large and giant intracranial aneurysms treated by endovascular approaches were retrospectively analyzed. Of the 20 patients, 9 had been treated by parent artery occlusion, 8 by coil embolization, and 3 with an intracranial covered stent. Two recurrent aneurysms initially treated with coil embolization were retreated with an intracranial covered stent. Patients were followed for 9-83 months after the procedure.

Results: Endovascular treatment was technically feasible in all 20 patients. One patient died 7 days after the procedure from rebleeding caused by incomplete aneurysmal occlusion. Immediate postprocedural angiograms showed that complete occlusion was achieved in 11 aneurysms, subtotal occlusion in 7, and incomplete occlusion in 2. The final angiographic results in the other 19 surviving patients confirmed complete occlusion of 15 aneurysms, subtotal occlusion in 3, and incomplete occlusion in 1. Clinical evaluations performed at the final follow-up visit showed an excellent outcome in 11 patients and a good outcome in 8.

Conclusion: Endovascular treatment of giant intracranial aneurysms with coil embolization is often associated with a low complete occlusion rate and a high recanalization rate, and parent artery occlusion remains a practical option in selected patients. Based on our limited experience, the use of an intracranial covered stent appears to be a relatively simple and safe procedure for occluding very large and giant aneurysms while still maintaining the patency of the parent artery.

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October 2007
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