Recovery from Cranial Nerve Symptoms after Flow Diversion without Coiling for Unruptured Very Large and Giant ICA Aneurysms

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FIGURE.
A, Left ICA angiogram showing a large aneurysm with a dome size of 19.0 mm located in the ophthalmic segment of the ICA. B, Follow-up angiogram at 1 year shows near-complete occlusion of the aneurysm. C, Visual field examination before treatment shows a visual field defect of the left eye. D, Follow-up examination at 1 year shows an improved visual field of the left eye. Additionally, the patient’s visual acuity improved from 0.3 to 0.8.

Table 1:

Comparison of clinical and radiologic outcomes between patients treated with flow diversion and those treated with conventional coiling^{^a}

Characteristics	Flow Diversion (n = 49)	Conventional Coiling (n = 30)	P Value
Radiologic outcomes
Initial occlusion grade
Not available	49 (100%)		<.001
Complete		13 (43.5%)
Remnant neck		8 (26.7%)
Sac filling		9 (30%)
One-year follow-up occlusion grade (flow-diversion coiling)			.154
OKM D/complete or near-complete	28 (62.2%)	13 (46.4%)
OKM C/remnant neck	12 (26.7%)	7 (25%)
OKM A and B/sac filling	5 (11.1%)	8 (28.6%)
Recurrence during follow-up	0 (0%)	12 (40%)	<.001
Retreatment	6 (12.2%)	7 (23.3%)	.197
Mean follow-up period (mo)	30.3 (SD, 18.7)	40.8 (SD, 25.6)	.111
Clinical outcomes
Cranial nerve symptom change			.046
Improved	15 (60%)	3 (25%)
Worsened or sustained	10 (40%)	9 (75%)
mRS ≥2 at discharge	2 (4.1%)	0 (0%)	.262
mRS ≥2 at last follow-up	5 (10.2%)	0 (0%)	.071
Mean follow-up period (mo)	33.0 (SD, 21.1)	45.9 (SD, 35.8)	.073

Table 2:

Univariate and multivariate analyses of the predictors associated with improvement of cranial nerve symptoms^{^a}

Variables	Univariate			Multivariate
	Recovery from Cranial Nerve Symptoms		P Value	Multivariate
	Yes (n = 17)	No (n = 21)	P Value	OR	95% CI	P Value
Age 60 years or older	6 (35.3%)	12 (57.1%)	.185
Hypertension	8 (47.1%)	6 (28.6%)	.253
Intradural location	8 (47.1%)	14 (66.7%)	.062	0.175	0.028–1.092	.092
Size ≥25 mm	5 (29.4%)	5 (23.8%)	.523
Mean size (mm)	22.9 (SD, 4.5)	23.0 (SD, 6.6)
Complete/near-complete occlusion	10 (58.8%)	8 (38.1%)	.630
Technique			.093	7.425	1.091–50.546	.040
Flow diversion	15 (88.2%)	13 (61.9%)
Conventional coiling	2 (11.8%)	8 (38.1%)

Table 3:

Treatment-related complications^{^a}

Characteristics	Flow Diversion (n = 49)	Conventional Coiling (n = 30)	P Value
Total complications	10 (20.4%)	6 (20%)	.965
Ischemic complications	3 (6.1%)	4 (13.3%)	.274
Symptomatic infarction	3 (6.1%)	2 (6.66%)
TIA or asymptomatic infarction	0 (0%)	2 (6.66%)
Size ≥20 mm	2/27 (7.4%)	0/7 (0%)	.458
Intradural location	2/26 (7.7%)	3/22 (13.6%)	.502
Hemorrhagic complications	4 (8.2%)	0 (0%)	.108
Early delayed aneurysmal rupture	3 (6.1%)	0 (0%)
Late delayed aneurysmal rupture	1 (2%)	0 (0%)
Size ≥ 20 mm	2/27 (7.4%)	0/7 (0%)	.458
Intradural location	4/26 (15.4%)	0/22 (0%)	.055
Mortality	4 (8.2%)	0 (0%)	.108
Size ≥ 20 mm	2/27 (7.4%)	0/7 (0%)	.458
Intradural location	4/26 (15.4%)	0/22 (0%)	.055