Endovascular treatment of giant aneurysms

Abstract

Giant aneurysms are classified as extradural and intradural. Extradural aneurysms include those located in the cervical, petrous, and cavernous segments of the internal carotid artery. The most frequently used method of endovascular treatment for these aneurysms is parent artery occlusion following temporary balloon occlusion test of the internal carotid artery. We use a simple tolerance test, without any adjunctive testing such as cerebral blood flow studies, with good reliability, low mortality, and no morbidity. Stenting of the parent artery and endosaccular coiling of the aneurysm prevails as the treatment of choice. Intradural giant aneurysms can be treated by endosaccular occlusion or by parent artery occlusion immediately proximal to the neck of the aneurysm or more proximally on the parent artery. The results of endosaccular occlusion of the giant aneurysms have been less satisfactory because of the dysplastic, wide neck of these aneurysms and frequent association of the intra-aneurysmal thrombus, which results in coil migration. Advances in stent technology may give an option of endosaccular coiling combined with stenting of the parent artery across the neck of not only extradural, but also intradural aneurysms. Parent artery occlusion just proximal to the aneurysm with or without bypass is especially effective for fusiform aneurysms, such as giant serpentine aneurysms. The indications for proximal parent artery occlusion for intradural aneurysms are decreasing and are limited to aneurysms in specific locations and with good collateral circulation.