Abstract
Large thrombosed aneurysms are highly associated with poor prognosis because of the compression of surrounding tissue by the enlarged aneurysm or a high risk of rupture. Treatment of this condition is also often difficult. Some clinicians select endovascular surgery in cases in which it is difficult to perform direct surgery, though the procedure is not an optimal treatment option for thrombosed aneurysms. We reviewed 10 patients with thrombosed aneurysm who received endovascular surgery in our department between January 1997 and December 2007. Their age range was 41 to 80 years (mean 60.9 years, M:F=2:8). Five patients had a lesion in the internal carotid artery and the other 5 in the posterior cranial fossa. Initial symptoms at onset included cranial nerve symptoms in 4, acute headache in 2, visual field defect in 1, subarachnoid bleeding in 1, and 2 were incidental cases. Seven of these patients were treated by intrasaccular embolization and 3 were treated by parent artery occlusion. In the 7 patients treated by intrasaccular embolization, 5 had a relapse after the coil was sunk into the thrombus and 3 underwent re-embolization. Symptomatic improvement was observed following embolization in all 4 patients with symptomatic unruptured aneurysms. One patient died of brain stem compression caused by aneurysm growth. In 3 patients treated by parent artery occlusion, symptomatic improvement was observed in 1 and visual field defect worsened in 1 patient. One patient died of ruptured basilar artery aneurysm 3 days after the occlusion of 1 vertebral artery.
Endovascular surgery may not be the best option for large thrombosed aneurysms. However, these treatment outcomes suggest that endovascular surgery is a treatment option for those in whom it is difficult to provide neck clipping who require rupture prevention and a short-term or temporal improvement in symptoms.
