A Contemporary Review of Endovascular Treatment of Wide-Neck Large and Giant Aneurysms

Abstract

Background: Despite widespread use of flow diverters, wide-necked large and giant aneurysms are still treated with other techniques as well. A contemporary review of results from different endovascular treatments is timely.

Methods: A literature review of the English language literature since 2011 was conducted using PubMed and Science Direct. Keywords and Medical Subheadings included large and giant aneurysms, ruptured aneurysms, aneurysms located in posterior circulation, and aneurysm occlusion status. Case reports were excluded. A combined model was built including both flow diverter and coil treatments in addition to separate models. Efficacy and safety were pooled using random effects analysis and regression.

Results: The review comprised 29 studies. For coiling techniques, complete occlusion was 40.2%-82.8%, and adjusted regression resulted in 53% (95% confidence interval [CI] 22%-81%). Flow diverter complete occlusion rate was 40.5%-87.8%, and adjusted regression resulted in 87% (95% CI 76%-93%). Overall occlusion rate for both techniques combined was 62%-75%, and adjusted regression resulted in 81% (95% CI 68%-89%). Overall stroke and death regression rate was 5% (95% CI 3%-10%); flow diverters showed slightly higher rates than coiling (6% vs. 3%).

Conclusions: All current treatments of large and giant wide-necked aneurysms have comparable safety and efficacy with a trend of superiority of efficacy toward flow diverters. Results of future treatment options and devices can be compared with current technology to evaluate feasibility.

Keywords: Cerebrovascular; Coil embolization; Endovascular treatment; Intracranial aneurysm.