Endovascular treatment of a symptomatic giant partially thrombosed aneurysm with saccular endovascular aneurysm lattice (SEAL) XL: The world's largest novel intrasaccular device.

Giant, partially thrombosed intracranial aneurysms (GPTIAs) remain among the most technically challenging cerebrovascular lesions to treat, particularly in patients with associated cranial nerve or brainstem compression. Unlike microsurgical clipping with or without decompression, endovascular coiling, parent vessel flow diversion, or parent vessel occlusion, intrasaccular embolization presents a unique opportunity for immediate aneurysm occlusion and reduction of mass effect without requiring long-term antiplatelets or parent vessel compromise. However, to date, no prior intrasaccular devices were available to treat GPTIAs, including the Food and Drug Administration-approved Woven EndoBridge device which could only accommodate aneurysms up to ∼11 mm in width. Here, we present the technical feasibility, safety, and efficacy of minimally invasive endovascular intrasaccular aneurysm embolization for GPTIAs with the novel saccular endovascular aneurysm lattice (SEAL) XL device engineered with a dual-layer mesh design and an expanded size matrix aneurysms up to 20 mm in diameter. Further data from larger prospective case series are needed to validate these promising initial findings.