• Yukiko Enomoto, Yusuke Egashira, Hirofumi Matsubara, Shinichi Yoshimura, and Toru Iwama.
• Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan. Electronic address: enomoto@gifu-u.ac.jp.
• World Neurosurg. 2020 Dec 1; 144: e507-e512.

ObjectiveLarge or giant thrombosed intracranial aneurysms (LGTIAs) are highly associated with poor prognosis and remain a challenging disease to treat by either surgery or endovascular treatment (EVT). EVT is considered more difficult for complicated aneurysm like LGTIAs. To understand long-term clinical and angiographic outcomes of EVT for LGTIAs, we retrospectively analyzed our single-center data on multimodality EVT for patients with LGTIAs.MethodsFrom the data of 35 EVT procedures performed in 31 consecutive patients with LGTIAs at our institution between December 2004 and December 2018, the rate of periprocedural complications, clinical outcomes at 12 months after EVT, and the rate of aneurysm recurrence were analyzed, and their related factors were evaluated.ResultsInitial EVTs were performed by deconstructive (n = 10) or reconstructive (n = 21) techniques. Although 5 patients (16%) died during the periprocedural period, 23 (74%) had good outcome at 12 months after the procedures. Among 26 patients with long-term follow-up, aneurysm recurrence was observed in 6 patients (23.1%; median time from treatment, 33.2 months). Aneurysm recurrence was significantly higher in patients with basilar artery aneurysm (P = 0.0421) and stroke (P = 0.0307); however, there was no significant difference between the procedures and devices used.ConclusionsMultimodality EVT for LGTIAs was performed with similar clinical outcomes and better radiologic outcomes compared with previous reports. New innovative techniques and devices are expected to be helpful for long-term aneurysm occlusion.Copyright © 2020 Elsevier Inc. All rights reserved.

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