Commentary on: Jahromi Babak, S.,Mocco, J.,Bang Jee, A.,Gologorsky, Yakov.,Siddiqui Adnan, H.,Horowitz Michael, B., et al: Clinical and angiographic outcome after endovascular management of giant intracranial aneurysms.. Neurosurgery 63(4): 662 - 74; discussion 674, 2008Keywords: aneurysm, coiling, angiography, endovascular embolization, cerebral angiographyInteractive Manuscript
Ask Questions of this Manuscript:
What questions did this manuscript seek to answer?
1) To determine the clinical outcomes of patients with giant aneurysms treated via endovascular coil embolization, parent vessel occlusion, and stent-assisted coiling. 2) To delineate the angiographic outcomes (parent vessel patency rate and aneurysm occlusion rate) of patients with giant aneurysms treated via coil embolization.
Describe the design of this manuscript.
Retrospective case-series
List the inclusion and exclusion criteria for the study population.
Inclusion criteria included all patients with aneurysms sized 25mm or greater treated between December 2001 and July 2007 at the University of Pittsburgh or University of Buffalo.
What were the results of this manuscript?
The authors demonstrated that at the time of last angiographic follow-up, 64% of patients had 95% or higher occlusion rates and 36% of patients had total 100% occlusion rates of their giant aneurysms. The rate of parent vessel patency was 74% in their series. Stents were required in the majority of cases and aneurysms were generally treated in a staged approach. The authors noted that at the time of last known clinical follow-up, (mean, 24.8 63% patients had GOS of 4 or 5; 10 patients experienced neurologic morbidity and 11 had died.
Highlight any other important points that this manuscript covered.
1) Patients who presented after aneurysm rupture had worse outcomes and required more treatment sessions than their non-ruptured counterparts. 2) The quoted occlusion rate does not necessarily convey the durability of final aneurysm obliteration because with giant aneurysms, the process of obliteration is a dynamic phenomenon and thus, noting the occlusion rate at a particular point in time might not accurately demonstrate true obliteration rate
Are there any questions or ideas for the future that you would pose to the authors?
1) Consider excluding the patients with cavernous carotid aneurysms from the series or note the results of these patients separately so as to not skew the data, given that the natural history of cavernous carotid aneurysms are different than other types of aneurysms. 2) What is the feasibility of performing a randomized study involving patients with these aneurysms (given their overall rarity) to open surgery versus endovascular therapy?
1) To determine the clinical outcomes of patients with giant aneurysms treated via endovascular coil embolization, parent vessel occlusion, and stent-assisted coiling. 2) To delineate the angiographic outcomes (parent vessel patency rate and aneurysm occlusion rate) of patients with giant aneurysms treated via coil embolization.
Retrospective case-series
Inclusion criteria included all patients with aneurysms sized 25mm or greater treated between December 2001 and July 2007 at the University of Pittsburgh or University of Buffalo.
The authors demonstrated that at the time of last angiographic follow-up, 64% of patients had 95% or higher occlusion rates and 36% of patients had total 100% occlusion rates of their giant aneurysms. The rate of parent vessel patency was 74% in their series. Stents were required in the majority of cases and aneurysms were generally treated in a staged approach. The authors noted that at the time of last known clinical follow-up, (mean, 24.8 63% patients had GOS of 4 or 5; 10 patients experienced neurologic morbidity and 11 had died.
1) Patients who presented after aneurysm rupture had worse outcomes and required more treatment sessions than their non-ruptured counterparts. 2) The quoted occlusion rate does not necessarily convey the durability of final aneurysm obliteration because with giant aneurysms, the process of obliteration is a dynamic phenomenon and thus, noting the occlusion rate at a particular point in time might not accurately demonstrate true obliteration rate
1) Consider excluding the patients with cavernous carotid aneurysms from the series or note the results of these patients separately so as to not skew the data, given that the natural history of cavernous carotid aneurysms are different than other types of aneurysms. 2) What is the feasibility of performing a randomized study involving patients with these aneurysms (given their overall rarity) to open surgery versus endovascular therapy?
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