J Cerebrovasc Endovasc Neurosurg.  2012 Mar;14(1):22-28. 10.7461/jcen.2012.14.1.22.

Clinical Analysis of Giant Intracranial Aneurysms with Endovascular Embolization

• Ha SW
• Jang SJ

• KMID: 1441681
• DOI: http://doi.org/10.7461/jcen.2012.14.1.22

Abstract

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.

Keyword

Giant intracranial aneurysm; endovascular coiling

MeSH Terms

Aneurysm
Angiography
Carotid Artery, Internal
Female
Follow-Up Studies
Humans
Intracranial Aneurysm
Male
Medical Records
Multiple Organ Failure
Stents
Vertebral Artery

Figure

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  Fig. 1 Giant aneurysm on left internal carotid artery (ICA) sized 45 × 31 mm, which compacted coils after 6 months follow-up and then coil compaction was progressed. Another session of coiling was performed. Brain computed tomography (CT) scan without contrast demonstrates an compressive mass (A). Three-dimensional CT angiogram demonstrates a giant aneurysm on left ICA (B). Post-1st Guglielmi detachable coil (GDC) angiogram demonstrates near-complete occlusion of the aneurysm (C). Angiogram demonstrates coil compaction at the neck region at 6 month follow-up (D). Angiogram after additional coiling demonstrates near-complete occlusion of aneurysm (E).

• 

  Fig. 2 We performed endovascular coiling on giant aneurysms on right ICA sized 23.4 × 25 mm but small portion of neck is remained unpacked. Three-dimensional CT angiogram demonstrates a giant aneurysm on right ICA (A). Post-GDC angiogram demonstrates small portion of aneurysmal neck unpacked (B and C).

• 

  Fig. 3 Giant aneurysm on right ICA sized 25 × 22 mm, which compacted coils and grew again after 12 months follow-up was performed another session of coiling with stent assisting on 24 months after initial session. And then it remained stabilized yet. Three-dimensional CT angiogram demonstrates a giant aneurysm on right ICA (A). Post-GDC (1st) angiogram demonstrates near-complete occlusion of the aneurysm (B). Angiogram demonstrates coil compaction at the neck region at 12 months follow-up (C). Angiogram after 1st additional coiling demonstrates near-complete occlusion of aneurysm (D). Angiogram demonstrates coil compaction at the neck region at 24 months follow-up (E). Angiogram after 2nd additional coiling demonstrates near-complete occlusion of aneurysm (F).

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