gms | German Medical Science

Objective: Treatment strategies for GIA are versatile and not well standardized. They may also vary significantly between different centers due to expertise or treatment bias. So far, no multicenter prospective interdisciplinary documentation of the types of treatments carried out in patients with GIA has been conducted. The international GIA Registry (GIA-R) is a pro- and retrospective analysis GIA. The aim was to better understand current treatment of GIA world-wide.

Methods: Between 2008 and June 2017, the GIA-R prospectively included 362 cases of GIA at 36 neurosurgical, neuroradiological or hybrid centers throughout Europe, Japan and the US. The only inclusion criterion was an intracranial aneurysm with a diameter of at least 25 mm. Each patient is followed-up for 5 years and we are documenting numerous clinical and radiological features as well as the type of treatment conducted.

Results: 362 cases were included. Mean age was 58 years, 58% were female. The mean aneurysm diameter was 32 mm and 46% were located on the ICA, 20% at the MCA, 10% at the ACA/AcomA and 24% in the posterior circulation. In the unruptured cohort (n=300), 22% were treated conservatively, 30% surgically and 48% endovascularly. In the ruptured cohort (n=62), 27% were treated conservatively, 34% surgically and 39% endovascularly. In unruptured cases, the most frequent surgical interventions were the placement of a cerebrovascular bypass combined with occlusion either proximal or distal to the GIA (38%), direct clipping of the aneurysm (18%), bypass only (14%), bypass combined with vessel reconstruction and occlusion (9%), only surgical vessel reconstruction (6%) or direct GIA clipping combined with bypass (6%). Unruptured endovascular cases most frequently underwent only flow diverter (FD) placement (27%), FD plus coiling (18%), coiling plus vessel occlusion (12%) or stent plus coiling (7%). In ruptured cases, surgical strategies included only direct clipping (40%), clipping and bypass (15%), clipping and surgical vessel reconstruction (10%) or only bypass (10%). Endovascular strategies in ruptured cases included only coiling (56%), only FD (11%), coiling plus occlusion (11%) or coiling plus FD in 4%.

Conclusion: In cases of ruptured GIA, fast treatment strategies, such as clipping or coiling, were favored by surgeons and neurointerventionists In elective unruptured GIA, clipping was only the 2nd most frequent surgical strategy behind the placement of a bypass and coiling was only performed in combination with other implants