A Contemporary Review of Endovascular Treatment of Wide-Neck Large/Giant Aneurysms.

BACKGROUND: Despite widespread use of flow diverters, wide-necked large and giant aneurysms are still treated with other techniques as well. OBJECTIVE: A contemporary review of results from different endovascular treatment is timely. METHODS: A literature review of the English language literature since 2011 was conducted using Pubmed and Science Direct. Keywords and MeSH terms included large and giant aneurysms, ruptured aneurysms, aneurysms located in posterior circulation and aneurysm occlusion status. Case reports were excluded. A combined model was built including both flow diverters and coils treatments in addition to separate models. Efficacy and safety were pooled using random effects analysis and regression. RESULTS: 29 studies were included in the review. For coiling techniques, complete occlusion ranged from 40.2% to 82.8%, adjusted regression resulted in 53% (95% CI 22% to 81%). Flow diverters complete occlusion rate ranged from 40.5% to 87.8%. Adjusted regression resulted in 87% (95% CI 76% to 93%). Combined results of both techniques overall occlusion rates ranged from 62% to 75% and adjusted regression revealed 81% (95% CI 68% to 89%). Overall stroke and death regression rates was 5% (95% CI 3% to 10%), while flow diverters showed slightly higher rates than coiling (6% vs 3%). CONCLUSIONS: All current approaches for treatment of large and giant wide-necked aneurysms have comparable safety and efficacy with a trend of superiority of efficacy towards flow diverters. Future treatment options and devices can compare its results to current technology to evaluate feasibility.