TY - JOUR
T1 - Treatment of Unruptured Large and Giant Carotid Cavernous Aneurysms in Japan at the Time of Flow Diverter Introduction
T2 - A Nationwide, Multicenter Survey by the Japanese Society on Surgery for Cerebral Stroke
AU - Yoshioka, Hideyuki
AU - Kanemaru, Kazuya
AU - Hashimoto, Koji
AU - Senbokuya, Nobuo
AU - Arai, Hajime
AU - Sakai, Nobuyuki
AU - Wakabayashi, Toshihiko
AU - Fujimura, Miki
AU - Miyamoto, Susumu
AU - Date, Isao
AU - Suzuki, Kensuke
AU - Inoue, Tooru
AU - Kuroiwa, Toshihiko
AU - Kuroda, Satoshi
AU - Tominaga, Teiji
AU - Kinouchi, Hiroyuki
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2025/3
Y1 - 2025/3
N2 - 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.
AB - 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.
KW - Carotid cavernous aneurysm
KW - Endovascular treatment
KW - Flow diverter
KW - Parent artery occlusion
UR - http://www.scopus.com/inward/record.url?scp=85216577253&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2024.123629
DO - 10.1016/j.wneu.2024.123629
M3 - 学術論文
C2 - 39736311
AN - SCOPUS:85216577253
SN - 1878-8750
VL - 195
JO - World Neurosurgery
JF - World Neurosurgery
M1 - 123629
ER -