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Endovascular treatment of giant or very large intracranial aneurysms with different modalities: an analysis of 20 cases

  • Interventional Neuroradiology
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Abstract

Introduction

The aim of this retrospective study was to evaluate the clinical efficacy and limitations of different endovascular modalities in the treatment of very large and giant intracranial aneurysms.

Methods

A group of 20 patients with very large and giant intracranial aneurysms treated by endovascular approaches were retrospectively analyzed. Of the 20 patients, 9 had been treated by parent artery occlusion, 8 by coil embolization, and 3 with an intracranial covered stent. Two recurrent aneurysms initially treated with coil embolization were retreated with an intracranial covered stent. Patients were followed for 9–83 months after the procedure.

Results

Endovascular treatment was technically feasible in all 20 patients. One patient died 7 days after the procedure from rebleeding caused by incomplete aneurysmal occlusion. Immediate postprocedural angiograms showed that complete occlusion was achieved in 11 aneurysms, subtotal occlusion in 7, and incomplete occlusion in 2. The final angiographic results in the other 19 surviving patients confirmed complete occlusion of 15 aneurysms, subtotal occlusion in 3, and incomplete occlusion in 1. Clinical evaluations performed at the final follow-up visit showed an excellent outcome in 11 patients and a good outcome in 8.

Conclusion

Endovascular treatment of giant intracranial aneurysms with coil embolization is often associated with a low complete occlusion rate and a high recanalization rate, and parent artery occlusion remains a practical option in selected patients. Based on our limited experience, the use of an intracranial covered stent appears to be a relatively simple and safe procedure for occluding very large and giant aneurysms while still maintaining the patency of the parent artery.

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Acknowledgements

We would like to thank Tina Kiss and Chi-Shing Zee, MD, of the Department of Radiology, University of Southern California for editing the English during preparation of the manuscript.

This study was supported by the Chinese National Natural Scientific Fund (contract number 30570540), the Shanghai Important Subject Fund of Medicine (contract number 05 III 023) and the Program for Shanghai Outstanding Medical Academic Leader (contract number LJ 06016).

Conflict of interest statement

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, The Sixth Affiliated People’s Hospital, Shanghai Jiao Tong University, No. 600, Yi Shan Road, Shanghai, China

    Ming-Hua Li, Yong-Dong Li, Chun Fang, Bing-Xian Gu, Ying-Sheng Cheng, Yong-Li Wang, Bu-Lang Gao, Jun-Gong Zhao, Ju Wang & Min Li

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  1. Ming-Hua Li
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Correspondence to Yong-Dong Li.

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Li, MH., Li, YD., Fang, C. et al. Endovascular treatment of giant or very large intracranial aneurysms with different modalities: an analysis of 20 cases. Neuroradiology 49, 819–828 (2007). https://doi.org/10.1007/s00234-007-0257-6

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  • DOI: https://doi.org/10.1007/s00234-007-0257-6

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