Comparison Of The Recurrence Rate Of Large Or Giant Intracranial Aneurysms Treated By Different Treatment Methods And Short-term Outcome Following Treatment Of Intracranial Aneurysms With Pipeline

BACKGROUNDLarge(10-25mm)and giant(>25mm)intracranial aneurysms account for 6-10%of all intracranial aneurysms,which giant intracranial aneurysms accounted for 4%-6%of all intracranial aneurysms.Large or giant intracranial aneurysms can rise from many points on the circumference of the cerebral artery,mostly on the anterior circulation.In the anterior circulation,these aneurysms are mostly situated on the cavernous segment of internal carotid artery(ICA),also on ophthalmic artery and middle cerebral artery.In the posterior circulation,these aneurysms are mostly situated on the basilar bifurcation and posterior cerebral artery.The growth mechanism of these aneurysms is similar to small intracranial aneurysms(<10mm).The vast majority of large or giant intracranial aneurysms manifest as a mass effect on the surrounding brain structures and cranial nerves,causing progressing focal neurological symptoms.In almost every fourth patient the pathology manifests as spontaneous subarachnoid hemorrhage(SAH).In some cases,the patients have ischemic disorders of cerebral circulation of thromboembolic origin.These aneurysms have a poor natural history and usually warrant intervention.Treatment options for large and giant aneurysms include open surgery or endovascular techniques.However,these aneurysms still remain a therapeutic challenge both surgically and endovascularly because of the size,intraluminal thrombosis,calcification,neck dimensions,involvement of perforator arteries,and proximity to cranial nerves and the brainstem.Endovascular treatment is now a well-established technique and it has been an increasingly used alternative to surgical clipping for large and giant intracranial aneurysms.However,endovascular treatment of these aneurysms is associated with high rates of recurrence,ranging from 35%to 87%.Intracranial stents are introduced to "reconstruct" the aneurysm neck and achieve more complete occlusion(allows denser aneurysm packing).But to date,there is still a controversial issue whether stent-assisted coiling could reduce the risk of recurrence for large and giant aneurysms.With the development of endovascular materials,flow diverter devices(FDDs)have emerged as a new generation of endoluminal implants that are designed to treat these aneurysms by reconstructing the diseased parent artery.Long-term results are not available concerning the safety and efficacy of FDDs or the occurrence of recurrence and late complications.The study,firstly,retrospectively compared the long-term angiographic outcomes of stent-assisted and nonstent-assisted coiling embolization in large and giant intracranial aneurysms at our center and identified predictors of aneurysms recurrence.Secondly,the objective of the study was to evaluate the efficacy of treatment of with large and giant cerebral arterial aneurysms using FDDs.Partl Stent-assisted versus Nonstent-assisted Coiling Embolization of Large and Giant Intracranial Aneurysms Long-term Follow-up Study of Aneurysm Recurrence RatesOBJECTIVE:To compare angiographic result at long-term follow-up,and rates of recurrence,and retreatment of stent-assisted coiled(SAC)and non-assisted coiled(NAC)large or intracranial aneurysms.METHODS:Retrospective evaluation of department records identified 90 patients with 91 large or giant intracranial aneurysms who had long-term angiographic follow-up and were successfully treated with SAC(39 aneurysms)or NAC(52 aneurysms)at the ZhuJiang Hospital from Jan,2004 to Jan.2016.The rates of initial angiographic results,recanalization,and retreatment were analyzed.Multivariate logistic regression analyses were performed to identify risks of aneurysm recurrence and retreatment at follow-up.RESULT:Recurrence and retreatment rates were 37.4%and 20.9%,respectively.There were more recurrent aneurysms in SAC group(14 of 39 aneurysms,35.9%)than in NAC group(21 of 52,40.4%)(P =0.663),but there were no significant differences in the rates of recurrence,retreatment.Multivariate logistic regression identified the use of stent as ruptured aneurysms(OR=0.284;95%Cl,.083-0.978;P=0.046),coiling alone(OR=5.03;95%CI,1.04-24.44;P=0.045)as predictions of aneurysm recurrence;and longer follow-up and hypertension as most predictive of aneurysm recurrence and retreatment.CONCLUSION:Stents were associated with a significant decrease of angiographic recurrences of large or giant aneurysms.Long-term angiographic follow-up is needed for both SAC and NAC aneurysms.Part2 Short-term Outcome Following Treatment of Intracranial Large and Aneurysms with Pipeline Embolization DeviceObjective:To present our preliminary experience and short-term safety and efficacy of Pipeline embolization device for the endovascular of intracranial aneurysms.Methods:Six patients treated with the PED between February 2016 and June 2016 were retrospectively analyzed.Clinical and angiographic results were assessed immediately and at follow-up.Result:Six patients(5 women;age range,44～67 years;average age,57years)with 6 intracranial aneurysms were treated during the study period.Mean aneurysm size was 18.3±9.2 mm.PED was technically successful in all aneurysms(100%).A total of 8 PEDs was used,and the mean number of devices per aneurysm was 1.3.Treatment was achieved with a single PED in 5 aneurysms,with 3 overlapping PEDs in 1 aneurysm.Adjunctive coiling was performed in 3 aneurysms.Aneurysm filling volumes of 6 patients were significantly reduced after PED implantation(the reduced filling ratios in 4 patients were 0-50%and in 2 were ≥50%).5 patients achieved good clinical outcome(mRS≤1)and no procedure-related complications occurred during follow-up.Conclusion:In our series,early results of the PED were encouraging.However,larger studies with longer follow-up duration are warranted to assess the safety and efficacy of the PED for treating intracranial aneurysms.