Treatment of Unruptured Large and Giant Carotid Cavernous Aneurysms in Japan at the Time of Flow Diverter Introduction: A Nationwide, Multicenter Survey by the Japanese Society on Surgery for Cerebral Stroke

Hideyuki Yoshioka, Kazuya Kanemaru, Koji Hashimoto, Nobuo Senbokuya, Hajime Arai, Nobuyuki Sakai, Toshihiko Wakabayashi, Miki Fujimura, Susumu Miyamoto, Isao Date, Kensuke Suzuki, Tooru Inoue, Toshihiko Kuroiwa, Satoshi Kuroda, Teiji Tominaga, Hiroyuki Kinouchi*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Flow diverters (FDs) were introduced for management of large or giant cavernous carotid aneurysms (CCAs) in addition to conventional modalities, dramatically changing treatment strategies. This study examined the management of unruptured large/giant CCAs in Japan when FDs were being introduced using a nationwide survey. Methods: A total of 540 unruptured large/giant CCAs treated at neurosurgical teaching departments in Japan between 2012 and 2016 were retrospectively studied. Results: Large CCAs were treated equally by parent artery occlusion (PAO), FD, and coiling, but giant aneurysms were occluded mainly by PAO. PAO was combined with revascularization in most cases. The nearly complete obliteration rate at final follow-up was higher after PAO (92.4%) than after FD (60.1%) and coiling (70.3%), and PAO was the most effective for ophthalmoparesis. Coiling had higher risks of recurrence and retreatment. Procedure-related major complications were observed in 9.6%. Cranial nerve symptoms were the most common complications, with coiling having significantly higher risks. All treatment modalities achieved good clinical outcomes (92.1%–96.1%); however, 5 delayed rupture cases were observed (1 PAO, 4 FD), resulting in 5 deaths (1 PAO, 1 FD). Conclusions: The nationwide survey reported here determined the status of treatment for unruptured large/giant CCAs in Japan when FDs were being introduced. Because PAO has disadvantages including the long-term hemodynamic effects of ICA occlusion, reconstructive treatment using FDs is optimal for this type of aneurysm; however, PAO can be an option in selected cases given the higher rates of complete occlusion and symptom improvement.

Original languageEnglish
Article number123629
JournalWorld Neurosurgery
Volume195
DOIs
StatePublished - 2025/03

Keywords

  • Carotid cavernous aneurysm
  • Endovascular treatment
  • Flow diverter
  • Parent artery occlusion

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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