Long-term follow-up of large and giant intracranial aneurysms managed by endovascular techniques: Experience from a tertiary care neurosurgery institute in India

Introduction: We present our experience of managing large and giant intracranial aneurysms by conventional endovascular techniques. We discuss the long-term clinical and angiographic outcome of coiling of these aneurysms. Materials and Methods: We assessed a prospectively maintained database of patients with large and giant intracranial aneurysms managed by the endovascular techniques from January 2010 to December 2014. In 412 patients with 468 aneurysms managed during this period, 58 patients with 60 aneurysms were identified as either large or giant. Each patient's records were reviewed with regard to size, location and morphology of the aneurysms, Hunt and Hess grade, occlusion and coiling/recoiling rates. Clinical outcome was assessed using the modified Rankin Scale (mRS) score with score of 0–2 and 3–6 taken as favourable and unfavourable outcome, respectively. Results: Overall complication rate was 13.8%, and no intraprocedural death was seen. Angiographic and clinical follow-up was available for 49 patients with 49 aneurysms at an average of 28.7 months. Recanalisation rate was 26.5% in this study and of them 38.5% required retreatment. Favourable mRS score (0–2) was seen in 82.6% of ruptured aneurysms and 92.3% in unruptured aneurysms. Conclusion: Coiling of large and giant aneurysms is a safe and viable option with a very good clinical outcome in the long run. However, long-term clinical and angiographic follow-up is necessary as angiographic results immediately after the procedure may be deceptive.