Clinical and angiographic outcome after endovascular management of giant intracranial aneurysms

Babak S. Jahromi, J. Mocco, Jee A. Bang, Yakov Gologorsky, Adnan H. Siddiqui, Michael B. Horowitz, L. Nelson Hopkins, Elad I. Levy

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: Giant (≥25 mm) intracranial aneurysms (IA) have an extremely poor natural history and continue to confound modern techniques for management. Currently, there is a dearth of large series examining endovascular treatment of giant IAs only. METHODS: We reviewed long-term clinical and radiological outcome from a series of 39 consecutive giant IAs treated with endovascular repair in 38 patients at 2 tertiary referral centers. Data were evaluated in 3 ways: on a per-treatment session basis for each aneurysm, at 30 days after each patient's final treatment, and at the last known follow-up examination. RESULTS: Ten (26%) aneurysms were ruptured. At the last angiographic follow-up examination (21.5 ± 22.9 months), 95% or higher and 100% occlusion rates were documented in 64 and 36% of aneurysms, respectively, with parent vessel preservation maintained in 74%. Stents were required in 25 aneurysms. Twenty percent of treatment sessions resulted in permanent morbidity, and death within 30 days occurred after 8% of treatment sessions. On average, 1.9 ± 1.1 sessions were required to treat each aneurysm, with a resulting cumulative per-patient mortality of 16% and morbidity of 32%. At the last known clinical follow-up examination (mean, 24.8 ± 24.8 months), 24 (63%) patients had Glasgow Outcome Scale scores of 4 or 5 ("good" or " excellent"), 10 patients had worsened neurological function from baseline (26% morbidity), and 11 had died (29% mortality). CONCLUSION: We present what is to our knowledge the largest series to date evaluating outcome after consecutive giant IAs treated with endovascular repair. Giant IAs carry a high risk for surgical or endovascular intervention. We hope critical and honest evaluation of treatment results will ensure continued improvement in patient care.

Original languageEnglish (US)
Pages (from-to)662-674
Number of pages13
JournalNeurosurgery
Volume63
Issue number4
DOIs
StatePublished - Oct 2008

Keywords

  • Endovascular treatment
  • Giant intracranial aneurysms
  • Outcomes

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Jahromi, B. S., Mocco, J., Bang, J. A., Gologorsky, Y., Siddiqui, A. H., Horowitz, M. B., Hopkins, L. N., & Levy, E. I. (2008). Clinical and angiographic outcome after endovascular management of giant intracranial aneurysms. Neurosurgery, 63(4), 662-674. https://doi.org/10.1227/01.NEU.0000325497.79690.4C