Background Giant Intracranial aneurysms (GIA) (≥25 mm) represent 5% of all intracranial aneurysms. GIAs rupture rates can reach 10% per year. Mortality rates for untreated GIA is between 65 and 100% in 2–5 years. Open surgical treatment of both ruptured and unruptured GIA carries a high risk with mortality rates between 6–22%. Endovascular treatment is a valuable option for these lesions. In particular, the use of endoluminal flow diverters may result in safe and high long-term occlusion rates. Therefore, we reviewed our experience with the endovascular treatment of ruptured and unruptured GIA.
Methods We performed a retrospective database analysis of consecutive patients with ruptured and unruptured GIA treated endovascularly at Miami Cardiac and Vascular Institute (MCVI) and Buffalo University (BU) in NY from October 2008 to April 2016. Clinical data as well as treatment technique, complications, clinical and imaging follow-up were assessed. Angiographic follow-up with DSA at 6 month post treatment was used to evaluate aneurysmal occlusion.
Results We found 36 consecutive patients (15 MCVI and 21 at BU). Mean age was 55 (median 56 years, range 16–82 years). Mean aneurysm size was 29.74 mm (range 25–50 mm). Eight patients (22%) presented with aneurysmal subarachnoid haemorrhage (aSAH), 28 patients (78%) were unruptured. Thirty-one aneurysms (86%) were located in the anterior circulation and five (14%) in the posterior circulation. Twenty-seven (75%) of the 36 giant aneurysms were treated with Pipeline Embolization Device (PED), 15 (41.7%) with single PED; 4 PED plus coiling (11.1%), 8 more than one PED, with or without coiling (22.2%). Eight (22.2%) were treated with coiling alone; four (11.1%) with stent-assisted coiling, two (5.5%) with balloon-assisted coiling. One patient was treated with parent vessel sacrifice. Other treatments included onyx embolization in one aneurysm (2.7%) and multiple stents in another (2.7%). Mortality for the entire cohort was 5/36 (13.9%). Three (8.3%) occurred in patients with aSAH; 2 in unruptured aneurysms. None of them was procedure related. Four patients (11.1%) experienced ischemic strokes. Two were patients presenting with aSAH, and 2 were patients with unruptured aneurysms. However, only 3 patients had 90 days mRS ≥3. The 6 month follow-up angiography was performed in 24/31 patients (77.5%). Eighteen (75%) patients had a Raymond Scale score of 1, three (12.5%) had a score of 2 and three (12.5%) had a score of 3.
Conclusions Endovascular embolization with PED or stent assisted coiling represents a safe and durable option for patients with both ruptured and unruptured GIA.
Disclosures I. Linfante: 2; C; Medtronic, Stryker, Penumbra. 3; C; Medtronic. 4; C; InNeuroCo, Three Rivers.
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