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Published on: September 8, 2023
Clinical analysis of giant intracranial aneurysms with endovascular embolization
1Department of Neurosurgery, College of medicine, Chosun University, Gwangju, Korea.
Insights
Endovascular embolization is a viable treatment for giant intracranial aneurysms, showing good outcomes in most patients. This minimally invasive approach offers an alternative to surgery for complex vascular conditions.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Interventional Radiology
Background:
- Giant intracranial aneurysms pose significant treatment challenges.
- Endovascular techniques offer a less invasive management option compared to open surgery.
Purpose of the Study:
- To clinically analyze the outcomes of nine patients with giant aneurysms treated with endovascular embolization.
- To evaluate the safety and efficacy of endovascular coiling and stenting for large intracranial aneurysms.
Main Methods:
- Retrospective review of nine patients (2 males, 7 females; ages 47-72) with giant intracranial aneurysms (8 internal carotid, 1 vertebral) treated between 2000-2009.
- Treatment strategies included endovascular coiling alone or with stent placement, chosen based on aneurysm and patient factors.
- Data collected from medical records, operation records, and postoperative/follow-up angiographies.
Main Results:
- Eight of nine patients achieved good or excellent clinical outcomes at a mean follow-up of 27.9 months.
- Near-complete occlusion was observed in 67% of patients post-procedure, with 89% achieving ≥90% occlusion.
- Four aneurysms required stent placement, and two needed retreatment due to regrowth; one patient died from unrelated complications.
Conclusions:
- Endovascular embolization is a feasible alternative for managing giant intracranial aneurysms.
- This approach can be considered adjuvant to surgical interventions, offering a less invasive treatment pathway.
Objective:
The purpose of this study was to perform a clinical analysis of nine patients with giant aneurysms managed with endovascular embolization.
Methods:
From March 2000 to September 2009, nine cases of giant intracranial aneurysms were treated (five unruptured and four ruptured). The nine patients included two males and seven females who were 47 to 72 years old (mean, 59.2 years old). The types of giant intracranial aneurysms were eight internal carotid artery aneurysms and one vertebral artery aneurysm. Treatment for each aneurysm was chosen based on anatomic relationships, aneurysmal factors, and the patients' clinical state. Three patients underwent endovascular coiling with stent and six initially underwent endovascular coiling alone. Medical records, operation records, postoperative angiographies, and follow-up angiographies were reviewed retrospectively.
Results:
Eight out of nine patients showed good clinical outcomes. (six were excellent and two were good) after a mean follow-up period of 27.9 months. Six (67%) of the nine patients had a near-complete occlusions on the post-operative angiogram (mean, 13.5 months after the procedure). Occlusion rates of 90% or higher were obtained for eight (89%) of all the patients. One patient died due to multiple organ failure. Stents were ultimately required at some point for managing four aneurysms. Two patients needed additional procedures because of aneurysm regrowth.
Conclusion:
Endovascular treatment could be an alternative option for managing giant aneurysms adjuvant to surgical intervention.
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