Treatment outcomes of large and giant intracranial aneurysms according to various treatment modalities
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ORIGINAL ARTICLE - VASCULAR NEUROSURGERY - ANEURYSM
Treatment outcomes of large and giant intracranial aneurysms according to various treatment modalities Jai Ho Choi 1 & Kwan Sung Lee 1 & Bum-soo Kim 2 & Yong Sam Shin 1 Received: 5 May 2020 / Accepted: 16 August 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Purpose This study aimed to compare the treatment outcomes of large (15–25 mm) and giant (> 25 mm) intracranial aneurysms (IAs), according to different treatment modalities. Methods In total, 112 patients with large and giant IAs treated with various treatment modalities between January 2009 and December 2018 were retrospectively reviewed. Clinical and radiological parameters were analyzed and correlated with the treatment modality. Results A total of 141 procedures were performed on 112 patients. We initially treated 47 cases with coil embolization, 39 with flow diverter (FD), 13 with direct clipping, and 13 with parent artery occlusion (PAO). Recurrence (46.8%) and retreatment (31.9%) rates were significantly higher in the coiling group (p < 0.001). Complete occlusion rate (36.3%) was significantly lower in the coiling group (p = 0.027). PAO could achieve a high complete occlusion rate (90.9%) with low complication rate (12.5%). The total complication rate was 17%. In the multivariate logistic regression analysis, FD (OR 3.406, p = 0.036) and direct clipping (OR 5.732, p = 0.017) showed a significantly higher complication rate than coiling. The overall mortality rate was 8% (8/139 procedures). At the last followup (mean 30.6 ± 26.4 months), 70 of 96 patients (72.9%) showed complete or near-complete occlusion. Good functional outcome (mRS ≤ 2) was observed in 90 of 112 (80.3%) patients at the last follow-up (mean 33.2 ± 30.5 months). Conclusions Good clinical and radiologic outcomes with acceptable complication and mortality rates can be achieved by various treatment modalities. The selection of appropriate modality should be individualized based on the angiographic findings and clinical symptoms. Keywords Intracranial aneurysm . Coil . Flow diverter . Clip . Parent artery occlusion
Introduction The treatment of large (15–25 mm) and giant (> 25 mm) intracranial aneurysms (IAs) is challenging for neurovascular This article is part of the Topical Collection on Vascular Neurosurgery Aneurysm Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00701-020-04540-1) contains supplementary material, which is available to authorized users. * Yong Sam Shin [email protected] 1
Department of Neurosurgery, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu,, Seoul, Korea
2
Department of Radiology, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul, Korea
neurosurgeons, because of its high rates of perioperative complication and recurrence [3, 13, 27, 33]. Treatment modalities of these aneurysms include surgical neck clipping, c
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