Treatment of giant intracranial aneurysms

Abstract

We report on report the clinical outcome obtained in treatment of giant intracranial aneurysms (GAs). Between 2005 and 2007, 51 patients with 51 GAs presented at our hospital. Twentynine were treated with primary parent vessel occlusion without distal bypass and ten underwent treatment preserving the parent artery. Twelve patients could not be treated endovascularly. Selective embolization (including two remodeling techniques and two stent-coil mbolizations) resulted in only one cure. Two patients died as a result of subarachnoid hemorrhage periprocedurely. Twenty-nine patients treated primarily with parent vessel occlusion and three patients treated with covered stent were considered cured after their treatments. Only one patient treated with parent vessel occlusion experienced ischemia during follow-up, which resulted in a mild neurological deficit. Of the twelve patients who could not be treated endovascularly, one succumbed to surgery, four died while being treated conservatively, and three were lost to follow-up. Parent artery occlusion, covered stent and coil occlusion provide effective protection against bleeding. In treatment of paraclinoid GAs of the internal carotid rtery, the use of a stent, and stent-assisted coil embolization may be a pitfall.

Figure 1

Patient 27. A) CT scanning showing a partially thrombosed mass with intramural hemorrhage in front of the brain stem. B) Right vertebral angiogram showing a giant dysplastic aneurysm of the basilar artery distal to the AICA origin. C,D) Left vertebral angiograms without (C) and with (D) subtraction showing the absence of aneurysm opacification after endovascular trapping with coils. E,F) Left common carotid (E) and right common carotid (F) angiograms showed an opacification of the basilar artery aneurysm. G-I) Control angiograms of left vertebral (G), left common carotid (H) and right common carotid (I) arteries showing the absence of aneurysm opacification showing a absence of opacification of the aneurysm one month after treatment.

Figure 2

Patient 39. A) Left common carotid angiogram showed a giant fusiform aneurysm in the cavernous carotid artery. Although the balloon was inflated twice, the aneurysm was still opacified after deployment of the first stent graft (4.5x16). B,C) Left internal carotid angiograms with (B) and without (C) subtraction showing the aneurysm opacification after deployment of the first Jostent and another Jostent (4.5x19) was introduced. D) The aneurysm was obliterated after the second stent graft was overlapped proximal to the first. E,F) Control angiogram of left common carotid artery (frontal view) at six months after treatment showing a complete disappearance of the aneurysm and a retrograde filling of the basilar artery from the anterior circulation.