Interventional Neuroradiologist Hospital Israelita Albert Einstein São Paulo, SP, Brazil
Introduction: Giant aneurysms (>25 mm) have often been a treatment challenge, needing bypass vascular surgery or complex reconstruction clipping techniques. Increasing familiarity with flow diverters for these difficult lesions have facilitated treatment all around the world.
Methods: We performed a retrospective study of five giant intracranial aneurysms treated with flow diversion between 2017 and 2022. Details regarding demographics, aneurysm characteristics, and aneurysms exclusion were obtained and analyzed.
Results: Four cases of giant intracranial aneurysms were described. One giant middle cerebral artery, 2 giant ophthalmic, and 1 giant cavernous segment of the internal carotid artery. All aneurysms were treated with flow diversion and coadjuvant loose coiling in 3 patients. Two patients were male and 2 were female, age ranging from 51 to 60 years old (mean 55.25). The clinical presentation was visual compromise in 2 and headache in 2 patients. Three were non ruptured and one ruptured aneurysm presenting with HH 3 Fisher 3 subarachnoid hemorrhage. None of the patients had neurological deficits related to the Endovascular treatment at the late follow up (>6 months). Two patients with giant ophthalmic aneurysms had worsening of the vision few weeks after endovascular treatment with improvement compared to the initial presentation during the clinical follow up to a year. There was no ischemic or hemorrhagic complication related to the treatment and no mortality. Four patients (100%) had complete occlusion at the follow up with MRA (1 patient) or DSA (3 patients).
Conclusion : Flow diverter stents for treatment of giant intracranial aneurysms has become possible with modern techniques. These challenging lesions can be cured effectively through endovascular approaches, without the need for open surgery and complex reconstructions or vascular bypasses. The outcomes of our center are similar to those in the literature.
