Introduction Giant partially thrombosed saccular intracranial aneurysms pose a unique management challenge.

Aim of Study The study aimed to describe the outcomes of the use of flow diversion in the treatment of giant partially thrombosed saccular intracranial aneurysms.

Methods Patients with giant partially thrombosed saccular intracranial aneurysms treated with flow diversion between 2013 and 2022 were retrospectively reviewed. Data on patient demographics, aneurysm characteristics, endovascular intervention, clinical outcome, and follow-up imaging were recorded.

Results Seven patients (57% female) underwent flow diversion, with an average age was 59. Two patients had hypertension, one was an active smoker, and one had a prior subarachnoid haemorrhage. Aneurysm location included the basilar artery tip (n=3), ICA (n=2), PCOM (n=1) and MCA (n=1). Mean maximal aneurysm dimension (thrombosed and filling component combined) was 32mm (24-60). Four patients had received prior endovascular management (coiling (n=3), coiling and WEB device (n=1)). Four types of flow diverter were used, with five patients receiving adjunctive coiling. Complications included flow diverter occlusion due to thrombus formation (n=1) necessitating mechanical thrombectomy and a change in antiplatelet agent, groin complications (n=1) managed medically, and re-presentation with subarachnoid haemorrhage from the vasa vasorum (n=1) resulting in death. All patients received follow-up, with a mean duration of 27.3 months. 71% had complete occlusion (RROC 1) and 85% had adequate occlusion (RROC 1-2) at most recent follow-up.

Conclusion Flow diversion is feasible option in the management of challenging giant partially thrombosed saccular intracranial aneurysms; safety and efficacy outcomes can yet be optimised through various means including routine antiplatelet testing.

Disclosure of Interest no.