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PT  - JOURNAL ARTICLE
AU  - Chalouhi, N.
AU  - Tjoumakaris, S.
AU  - Gonzalez, L.F.
AU  - Dumont, A.S.
AU  - Starke, R.M.
AU  - Hasan, D.
AU  - Wu, C.
AU  - Singhal, S.
AU  - Moukarzel, L.A.
AU  - Rosenwasser, R.
AU  - Jabbour, P.
TI  - Coiling of Large and Giant Aneurysms: Complications and Long-Term Results of 334 Cases
AID  - 10.3174/ajnr.A3696
DP  - 2014 Mar 01
TA  - American Journal of Neuroradiology
PG  - 546--552
VI  - 35
IP  - 3
4099  - http://www.ajnr.org/content/35/3/546.short
4100  - http://www.ajnr.org/content/35/3/546.full
SO  - Am. J. Neuroradiol.2014 Mar 01; 35
AB  - BACKGROUND AND PURPOSE: Large and giant intracranial aneurysms are increasingly treated with endovascular techniques. The goal of this study was to retrospectively analyze the complications and long-term results of coiling in large and giant aneurysms (≥10 mm) and identify predictors of outcome. MATERIALS AND METHODS: A total of 334 large or giant aneurysms (≥10 mm) were coiled in our institution between 2004 and 2011. Medical charts and imaging studies were reviewed to determine baseline characteristics, procedural complications, and clinical/angiographic outcomes. Aneurysm size was 15 mm on average. Two hundred twenty-five aneurysms were treated with conventional coiling; 88, with stent-assisted coiling; 14, with parent vessel occlusion; and 7, with balloon-assisted coiling. RESULTS: Complications occurred in 10.5% of patients, with 1 death (0.3%). Aneurysm location and ruptured aneurysms predicted complications. Angiographic follow-up was available for 84% of patients at 25.4 months on average. Recanalization and retreatment rates were 39% and 33%, respectively. Larger aneurysm size, increasing follow-up time, conventional coiling, and aneurysm location predicted both recurrence and retreatment. The annual rebleeding rate was 1.9%. Larger aneurysm size, increasing follow-up time, and aneurysm location predicted new or recurrent hemorrhage. Favorable outcomes occurred in 92% of patients. Larger aneurysm size, poor Hunt and Hess grades, and new or recurrent hemorrhage predicted poor outcome. CONCLUSIONS: Coiling of large and giant aneurysms has a reasonable safety profile with good clinical outcomes, but aneurysm reopening remains very common. Stent-assisted coiling has lower recurrence, retreatment, and new or recurrent hemorrhage rates with no additional morbidity compared with conventional coiling. Aneurysm size was a major determinant of recanalization, retreatment, new or recurrent hemorrhage, and poor outcome. GOSGlasgow Outcome ScorePEDPipeline Embolization Device