J Cerebrovasc Endovasc Neurosurg.  2021 Jun;23(2):99-107. 10.7461/jcen.2021.E2020.08.008.

Endovascular management of large and giant intracranial aneurysms: Experience from a tertiary care neurosurgery institute in India

• Dutta G
• Singh D
• Jagetia A
• Srivastava AK
• Singh H
• Kumar A

• KMID: 2517022
• DOI: http://doi.org/10.7461/jcen.2021.E2020.08.008

Abstract

Objective
With the development of endovascular technique and devices, large and giant intracranial aneurysms are increasingly being managed by this less invasive method. Here we discuss our experience on managing such aneurysms via endovascular technique.
Methods
Retrospective data on 42 patients with large and giant intracranial aneurysms managed by endovascular techniques between September 2015 to December 2017 at our neurosurgery institute were included in this analysis.
Results
There were a total 42 patients with 9 giant and 33 large aneurysms in this study. Eight aneurysms were treated by parent vessel occlusion, 22 aneurysms with coils and rest 12 aneurysms were treated with stent assisted coiling. Following the procedure, Raymond class I occlusion was accomplished in 31 (73.8%) patients while class Ⅱ in 9 (21.4%) and class Ⅲ in 2 (4.8%) patients. Overall morbidity and mortality were 9.5% and 14.3% respectively and favorable outcome was seen in 80.9% patients. Significant correlation was observed with clinical outcome and initial neurological status.
Conclusions
The study indicates that endovascular intervention is a safe and effective method in managing large and giant intracranial aneurysms with lesser morbidity and mortality.

Keyword

Angiography; Coiling; Endovascular management; Intracranial aneurysms; Large and giant; Stenting

Figure

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  Fig. 1. (A) Non-contrast computed tomography brain showing a slightly hyperdense area anterior to the midbrain. (B) CT Angiography brain showing a giant saccular aneurysm but the site of origin could not be established. (C) DSA showing a basilar top aneurysm filling from the left vertebral artery. (D) Post coiling DSA showing decreased filling. CT, computed tomography; DSA, digital subtraction angiography.

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  Fig. 2. (A) DSA showing a large saccular aneurysm arising from left cavernous segment directed antero-medially. (B) Post-SAC procedure showing satisfactory obliteration of the sac. DSA, digital subtraction angiography; SAC, stent-assisted coiling.

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