• Shigeru Miyachi, Hiroyuki Ohnishi, Ryo Hiramatsu, Takashi Izumi, Noriaki Matsubara, and Toshihiko Kuroiwa.
• Department of Neurosurgery and Endovascular Therapy, Osaka Medical College, Osaka, Japan. Electronic address: neu137@poh.osaka-med.ac.jp.
• J Stroke Cerebrovasc Dis. 2017 May 1; 26 (5): 1071-1080.

BackgroundThe efficacy for the treatment of large carotid cavernous aneurysms (CCAs) was compared between conventional endovascular treatments, stent-assisted coiling (SAC), parent artery occlusion (PAO), and the flow diverter (FD).MethodsBetween January 2001 and December 2015, 49 patients with large, broad-necked, unruptured CCA underwent endovascular treatment at our institution. We performed PAO in 22 patients, SAC in 18 patients, and FD in 9 patients. Safety and efficacy were assessed in all patients by periodic clinical and radiological examinations during a 6-month follow-up.ResultsAll 22 aneurysms treated with PAO disappeared immediately after treatment, but in the SAC-treated group, complete occlusion was obtained in only 5 of the 18 patients. All aneurysms in the FD group resulted in body filling. Perioperative ipsilateral temporary ischemic events occurred in 6 cases (PAO 4, SAC 2, FD 0). Delayed deterioration or new onset of cranial nerve symptoms was observed in 10 cases (PAO 3, SAC 3, FD 4), almost all of which recovered within 3 months. During the 6-month follow-up, all aneurysms treated with PAO showed a decrease in size without recanalization. In the SAC group, 12 aneurysms showed neck remnants, and marked recanalization occurred in 4 cases. Six of the 9 aneurysms in the FD group were completely occluded.ConclusionsThe FD provided excellent final results despite transient worsening of symptoms. Although further long-term follow-up is essential, from a cost-effective and time-saving viewpoint, FD is a relatively safe and reliable method for the treatment of large CCAs.Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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