Abstract
Despite major progress in treating aneurysms by coil embolization, the complete occlusion of aneurysms of >10 mm in diameter (large/giant aneurysms) remains challenging. We present a novel endovascular treatment method for large and giant cerebral aneurysms called the "maze-making and solving" technique and compare the short-term follow-up results of this technique with those of conventional coil embolization. Eight patients (65 ± 11.5 years of age, 7 women) with large/giant unruptured nonthrombosed cerebral aneurysm (mean largest aneurysm dimension, 19 ± 4.4 mm) were treated by the maze-making and solving technique, a combination of the double-catheter technique and various assisted techniques. The coil-packing attenuation, postoperative courses, and recurrence rate of this maze group were compared with 30 previous cases (conventional group, 65.4 ± 13.0 years of age; 22 women; mean largest aneurysm dimension, 13.4 ± 3.8 mm). Four maze group cases were Raymond class 1; and 4 were class 2 as indicated by immediate postsurgical angiography. No perioperative deaths or major strokes occurred. Mean packing attenuation of the maze group was significantly higher than that of the conventional group (37.4 ± 5.9% versus 26.2 ± 5.6%). Follow-up angiography performed at 11.3 ± 5.4 months revealed no recurrence in the maze group compared with 39.2% in the conventional group. The maze-making and solving technique achieves high coil-packing attenuation for efficient embolization of large and giant cerebral aneurysms with a low risk of recurrence.
Highlights
BACKGROUND AND PURPOSEDespite major progress in treating aneurysms by coil embolization, the complete occlusion of aneurysms of Ͼ10 mm in diameter remains challenging
Large and giant aneurysms remain difficult to treat by using assist techniques and bioactive coils,[1,2] possibly because the requisite coil-packing attenuation is often not achieved
We recently developed a “maze-making and solving” technique to occlude these large/giant aneurysms by achieving high packing attenuation
Summary
Eight patients (65 Ϯ 11.5 years of age, 7 women) with large/giant unruptured nonthrombosed cerebral aneurysm (mean largest aneurysm dimension, 19 Ϯ 4.4 mm) were treated by the maze-making and solving technique, a combination of the double-catheter technique and various assisted techniques. The coil-packing attenuation, postoperative courses, and recurrence rate of this maze group were compared with 30 previous cases (conventional group, 65.4 Ϯ 13.0 years of age; 22 women; mean largest aneurysm dimension, 13.4 Ϯ 3.8 mm). This was a retrospective study of 42 patients with a large or giant (diameter, Ͼ10 mm),[3] nonthrombosed, unruptured aneurysm who received endovascular treatment at our hospital between February 2007 and December 2013. The follow-up period was defined as the number of months postsurgery to recurrence or to the latest angiogram
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