Endosaccular Treatment of Very Large and Giant Intracranial Aneurysms with Parent Artery Preservation: Single Center Experience with Long Term Follow-up
10.3340/jkns.2017.0606.004
- Author:
Chae Wook HUH
1
;
Jae Il LEE
;
Chang Hwa CHOI
;
Tae Hong LEE
;
Jae Young CHOI
;
Jun Kyeung KO
Author Information
1. Department of Neurosurgery, Inje University Haeundae Paik Hospital, Busan, Korea.
- Publication Type:Original Article
- Keywords:
Giant intracranial aneurysm;
Embolization;
Reconstruction
- MeSH:
Aneurysm;
Arteries;
Cohort Studies;
Embolization, Therapeutic;
Female;
Follow-Up Studies;
Hand;
Humans;
Intracranial Aneurysm;
Male;
Mortality;
Neck;
Parents
- From:Journal of Korean Neurosurgical Society
2018;61(4):450-457
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: Very large (20–25 mm) and giant (≥25 mm) intracranial aneurysms have an extremely poor natural course, and treatment of these aneurysms remains a challenge for endovascular and surgical strategies. This study was undertaken to describe our experiences of endosaccular treatment of very large and giant intracranial aneurysms with parent artery preservation.METHODS: From January 2005 to October 2016, twenty-four very large or giant aneurysms in 24 patients were treated by endosaccular coil embolization with parent artery preservation. Nine (37.5%) aneurysms were ruptured and 15 were unruptured, and of these 15, 11 were symptomatic cases and 4 were incidentally discovered. The cohort comprised 17 women and 7 men of mean age 58.5 years (range, 26–82). Mean aneurysm size was 26.0 mm (range, 20–39) and 13 of the 24 aneurysms were giant.RESULTS: Immediate angiographic results were complete occlusion in nine (37.5%) cases, remnant neck in six (25.0%), and remnant sac in nine (37.5%). Overall procedural related morbidity and mortality rates were 12.5% and 4.2%, respectively. Angiographic follow-up was available in 16 patients (66.7%). Mean and median follow-up periods were 27.2 (range, 2–77) and 10.5 months, respectively. In 12 cases (12/16, 75%) stable occlusion was achieved, four cases (4/16, 25%) had recanalized, and two of these were retreated with additional coiling. At clinical follow-up of the nine ruptured cases, three patients (33.3%) achieved a good clinical outcome (Glasgow outcome scale [GOS] score of 4 or 5), two (22.2%) a poor outcome (GOS score of 2 or 3), and four patients (44.4%) expired (GOS 1). On the other hand, of the 15 unruptured cases, 13 patients (86.7%) achieved a good clinical outcome (GOS 4 or 5), one patient a poor outcome (GOS score of 2 or 3), and one patient expired (GOS 1).CONCLUSION: The present study shows endosaccular treatment of very large or giant intracranial aneurysms with parent artery preservation is both feasible and effective with acceptable morbidity and mortality.
