Endovascular Treatment of Large and Giant Aneurysms

Abstract

SUMMARY:Very large and giant (Ն15 mm) cerebral aneurysms have a poor natural history, with high risk of subarachnoid hemorrhage or progressive symptoms of mass effect. Several endovascular techniques may be applied for treatment, depending on location, size, anatomy and presence of collateral circulation. The authors reviewed their clinical experience in endovascular treatment of 232 very large and giant aneurysms and present their perspective on the present state of the art in endovascular therapy for these aneurysms.

Pipeline Embolization Device in Aneurysmal Subarachnoid Hemorrhage

“…In a later stage, after the vasospasm period, a more definitive treatment can be considered. 44 Deconstructive techniques remain safe and effective, with good clinical and angiographic long-term outcomes. 45 Nonetheless aneurysms may continue to grow due to hypertrophic vasa vasorum and subadventitial hemorrhages.…”

Therapeutic Internal Carotid Artery Occlusion for Large and Giant Aneurysms: A Single Center Cohort of 146 Patients

“…Endovascular treatment can consist of ICA balloon occlusion, selective coiling with or without balloon or stent assistance, or parent ICA reconstruction with flow diverters. [6][7][8][9] At the Sint Elisabeth Ziekenhuis, therapeutic ICA occlusion has been the preferred treatment for large and giant ICA aneurysms since 1995, despite the availability in the last decade of new endovascular devices, such as stents and flow diverters, intended to spare the parent ICA. We report the clinical and imaging results of ICA occlusion for aneurysms in a large single-center patient cohort.…”

The Maze-Making and Solving Technique for Coil Embolization of Large and Giant Aneurysms

“…The natural course of an unruptured cerebral aneurysm is influenced by size, 13,14 and larger cerebral aneurysms have a poor prognosis, with a high risk of subarachnoid hemorrhage or progressive symptoms due to a mass effect. 15 In addition, large and giant aneurysms often have thicker atheromatous walls that prevent simple neck clipping. 16 Several treatment strategies, such as parent vessel occlusion, selective aneurysmal occlusion, and application of a flow-diverting stent, have been used for the treatment of large and giant aneurysms.…”