Treatment outcomes of large and giant intracranial aneurysms according to various treatment modalities

Abstract

Purpose This study aimed to compare the treatment outcomes of large (15-25 mm) and giant (> 25 mm) intracranial aneurysms (IAs), according to different treatment modalities. Methods In total, 112 patients with large and giant IAs treated with various treatment modalities between January 2009 and December 2018 were retrospectively reviewed. Clinical and radiological parameters were analyzed and correlated with the treatment modality. Results A total of 141 procedures were performed on 112 patients. We initially treated 47 cases with coil embolization, 39 with flow diverter (FD), 13 with direct clipping, and 13 with parent artery occlusion (PAO). Recurrence (46.8%) and retreatment (31.9%) rates were significantly higher in the coiling group (p < 0.001). Complete occlusion rate (36.3%) was significantly lower in the coiling group (p = 0.027). PAO could achieve a high complete occlusion rate (90.9%) with low complication rate (12.5%). The total complication rate was 17%. In the multivariate logistic regression analysis, FD (OR 3.406, p = 0.036) and direct clipping (OR 5.732, p = 0.017) showed a significantly higher complication rate than coiling. The overall mortality rate was 8% (8/139 procedures). At the last followup (mean 30.6 ± 26.4 months), 70 of 96 patients (72.9%) showed complete or near-complete occlusion. Good functional outcome (mRS ≤ 2) was observed in 90 of 112 (80.3%) patients at the last follow-up (mean 33.2 ± 30.5 months). Conclusions Good clinical and radiologic outcomes with acceptable complication and mortality rates can be achieved by various treatment modalities. The selection of appropriate modality should be individualized based on the angiographic findings and clinical symptoms.

A Single Flow Re-direction Endoluminal Device for the Treatment of Large and Giant Anterior Circulation Intracranial Aneurysms

“… 9 We thought that the complication rate was relatively high in this study for the following reasons: 1) we treated large and giant IAs with the maximal diameter larger than 15 mm, except for three fusiform aneurysms; and 2) the proportion of non-ICA locations, including the middle and anterior cerebral arteries (n=11, 33.3%), was relatively high. Choi, et al 18 have reported that the complication and mortality rates of FDS for large and giant IAs in a single-center series were 18.7% and 8.3%, respectively. These results were similar to the findings of the current study, as the indication for the use of FDS is the same in our country.…”

“…However, additional coil packing is not permitted in South Korea, as we previously described. 18 Strict blood pressure control to lower direct hemodynamic stress on aneurysm wall and steroid therapy to reduce thrombus-related inflammation can be used to avoid this fatal complication. 18 …”

“… 18 Strict blood pressure control to lower direct hemodynamic stress on aneurysm wall and steroid therapy to reduce thrombus-related inflammation can be used to avoid this fatal complication. 18 …”

Surgical Clipping Versus Endovascular Coiling in the Management of Intracranial Aneurysms

“…The most considerable discrepancy in the rate of occlusion between clipping and coiling occurs in the treatment of large (15-25 mm) and giant aneurysms (>25 mm). A retrospective study published in 2020 by Choi et al analyzing 112 patients with large and giant aneurysms found the complete occlusion rate after coiling to be just 36.3%, compared to 90.9% in the surgical group [ 79 ]. Thus, recurrence and retreatment rates were also significantly high at 46.8% and 31.9%, respectively.…”

A randomized controlled study comparing microsurgical clipping via the keyhole approach, conventional craniotomy, and endovascular coiling for ruptured anterior circulation aneurysms

“…The rapid development of endovascular treatment techniques has expanded the indications for the treatment of intracranial aneurysms [25], but at present, some aneurysms are better suited for surgical clipping. For example, for wide-necked aneurysms, no subsequent treatment of double antiplatelet due to stent implantation during endovascular treatment is required after surgical clipping; for patients with obvious intracranial hemorrhage, the hematoma can be removed and decompressed at the time of surgical clipping, or the hemorrhagic cerebrospinal uid can be fully released to reduce the incidence of vasospasm and hydrocephalus; clipping and shaping of giant aneurysms can achieve a great effect; and surgical clipping is still a better option for patients with intracranial arterial tortuosity and for aneurysms that are hard to reach with the catheter guide wire [5,22,23,35]. For long-term e cacy, endovascular treatment still has a certain recurrence rate.…”