• Simone Peschillo, Alessandro Caporlingua, Maria Chiara Resta, Jo Peter Paul Peluso, Nicola Burdi, Nader Sourour, Francesco Diana, Giulio Guidetti, Frédéric Clarençon, Gijs Coenraad Bloemsma, Federico Di Maria, Massimo Donatelli, and Maurizio Resta.
• Department of Neurology and Psychia-try, Endovascular Neurosurgery/Interven-tional Neuroradiology, 'Sapienza' Univers-ity of Rome, Rome, Italy.
• Oper Neurosurg (Hagerstown). 2017 Aug 1; 13 (4): 492-502.

BackgroundAlthough flow diverters (FDs) have been widely accepted by neurointerventionists, their safety has yet to be fully defined. Stratification by aneurysm size and location is essential for correct evaluation of treatment outcomes and risks of flow diversion.ObjectiveTo compare neurological and anatomic outcomes and evaluate the risk of complications after endovascular treatment of large or giant internal carotid artery (ICA) aneurysms with FD/FDs alone or together with coil embolization.MethodsWe reviewed all patients with large or giant, ruptured or unruptured ICA aneurysms who underwent endovascular treatment with flow diversion alone (group A) or with concomitant coiling (group B) in 4 international institutions between 2010 and 2015. Anatomic outcome was evaluated using the Byrne scale on digital subtraction angiography and/or angioMRI and/or angioCT scans 3, 6, 12, and 24 months postoperatively.ResultsWe collected 44 patients with large or giant ICA aneurysms. Four patients (9%) presented with aneurysmal subarachnoid hemorrhage (SAH). FD/FDs were used alone in 26 patients and in combination with coil embolization in the 18 remaining patients. The mortality rate due to procedure-related and/or neurological complications was 2.2%. Twelve months after the procedure, 88.6% (n = 39) of patients had a favorable neurological outcome. One year after the procedure, the aneurysm was completely occluded in 72.7% of patients: 61.5% (16/18) in group A and 88.9% (16/26) in group B.ConclusionClinical outcomes and rates of intraoperative and postoperative complications did not differ significantly between the groups. Better anatomic results using FD/FDs combined with coils were documented 6 months after the procedure; this option seems to provide a higher aneurysm occlusion rate and reduce the need for retreatment.Copyright © 2017 by the Congress of Neurological Surgeons

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