BACKGROUND AND PURPOSE: Large and giant intracranial aneurysms are increasingly treated with endovascular techniques. The goal of this study was to retrospectively analyze the complications and long-term results of coiling in large and giant aneurysms (≥ 10 mm) and identify predictors of outcome. MATERIALS AND METHODS: A total of 334 large or giant aneurysms (≥ 10 mm) were coiled in our institution between 2004 and 2011. Medical charts and imaging studies were reviewed to determine baseline characteristics, procedural complications, and clinical/angiographic outcomes. Aneurysm size was 15 mm on average. Two hundred twenty-five aneurysms were treated with conventional coiling; 88, with stent-assisted coiling; 14, with parent vessel occlusion; and 7, with balloon-assisted coiling. RESULTS: Complications occurred in 10.5% of patients, with 1 death (0.3%). Aneurysm location and ruptured aneurysms predicted complications. Angiographic follow-up was available for 84% of patients at 25.4 months on average. Recanalization and retreatment rates were 39% and 33%, respectively. Larger aneurysm size, increasing follow-up time, conventional coiling, and aneurysm location predicted both recurrence and retreatment. The annual rebleeding rate was 1.9%. Larger aneurysm size, increasing follow-up time, and aneurysm location predicted new or recurrent hemorrhage. Favorable outcomes occurred in 92% of patients. Larger aneurysm size, poor Hunt and Hess grades, and new or recurrent hemorrhage predicted poor outcome. CONCLUSIONS: Coiling of large and giant aneurysms has a reasonable safety profile with good clinical outcomes, but aneurysm reopening remains very common. Stent-assisted coiling has lower recurrence, retreatment, and new or recurrent hemorrhage rates with no additional morbidity compared with conventional coiling. Aneurysm size was a major determinant of recanalization, retreatment, new or recurrent hemorrhage, and poor outcome.
BACKGROUND AND PURPOSE: Large and giant intracranial aneurysms are increasingly treated with endovascular techniques. The goal of this study was to retrospectively analyze the complications and long-term results of coiling in large and giant aneurysms (≥ 10 mm) and identify predictors of outcome. MATERIALS AND METHODS: A total of 334 large or giant aneurysms (≥ 10 mm) were coiled in our institution between 2004 and 2011. Medical charts and imaging studies were reviewed to determine baseline characteristics, procedural complications, and clinical/angiographic outcomes. Aneurysm size was 15 mm on average. Two hundred twenty-five aneurysms were treated with conventional coiling; 88, with stent-assisted coiling; 14, with parent vessel occlusion; and 7, with balloon-assisted coiling. RESULTS: Complications occurred in 10.5% of patients, with 1 death (0.3%). Aneurysm location and ruptured aneurysms predicted complications. Angiographic follow-up was available for 84% of patients at 25.4 months on average. Recanalization and retreatment rates were 39% and 33%, respectively. Larger aneurysm size, increasing follow-up time, conventional coiling, and aneurysm location predicted both recurrence and retreatment. The annual rebleeding rate was 1.9%. Larger aneurysm size, increasing follow-up time, and aneurysm location predicted new or recurrent hemorrhage. Favorable outcomes occurred in 92% of patients. Larger aneurysm size, poor Hunt and Hess grades, and new or recurrent hemorrhage predicted poor outcome. CONCLUSIONS: Coiling of large and giant aneurysms has a reasonable safety profile with good clinical outcomes, but aneurysm reopening remains very common. Stent-assisted coiling has lower recurrence, retreatment, and new or recurrent hemorrhage rates with no additional morbidity compared with conventional coiling. Aneurysm size was a major determinant of recanalization, retreatment, new or recurrent hemorrhage, and poor outcome.
Authors: Rafael Martinez-Perez; Douglas A Hardesty; Giuliano Silveira-Bertazzo; Thiago Albonette-Felicio; Ricardo L Carrau; Daniel M Prevedello Journal: Neurosurg Rev Date: 2020-05-26 Impact factor: 3.042
Authors: N Chalouhi; S Tjoumakaris; J L H Phillips; R M Starke; D Hasan; C Wu; M Zanaty; D Kung; L F Gonzalez; R Rosenwasser; P Jabbour Journal: AJNR Am J Neuroradiol Date: 2014-04-30 Impact factor: 3.825
Authors: W Brinjikji; P M White; H Nahser; J Wardlaw; R Sellar; H J Cloft; D F Kallmes Journal: AJNR Am J Neuroradiol Date: 2015-03-12 Impact factor: 3.825
Authors: Lei Huang; Wenjie Cao; Liang Ge; Gang Lu; Jun Wan; Lei Zhang; Weijin Gu; Xiaolong Zhang; Daoying Geng Journal: Int J Clin Exp Med Date: 2015-05-15
Authors: M-A Labeyrie; S Lenck; D Bresson; J-P Desilles; A Bisdorff; J-P Saint-Maurice; E Houdart Journal: AJNR Am J Neuroradiol Date: 2014-07-31 Impact factor: 3.825
Authors: David F Kallmes; Waleed Brinjikji; Edoardo Boccardi; Elisa Ciceri; Orlando Diaz; Rabih Tawk; Henry Woo; Pascal Jabbour; Felipe Albuquerque; Rene Chapot; Alain Bonafe; Shervin R Dashti; Josser E Delgado Almandoz; Curtis Given; Michael E Kelly; DeWitte T Cross; Gary Duckwiler; Nasser Razack; Ciaran J Powers; Sebastian Fischer; Demetrius Lopes; Mark R Harrigan; Daniel Huddle; Raymond Turner; Osama O Zaidat; Luc Defreyne; Vitor Mendes Pereira; Saruhan Cekirge; David Fiorella; Ricardo A Hanel; Pedro Lylyk; Cameron McDougall; Adnan Siddiqui; Istvan Szikora; Elad Levy Journal: Interv Neurol Date: 2016-05-26