Flow Diversion versus Traditional Endovascular Coiling Therapy: Design of the Prospective LARGE Aneurysm Randomized Trial

Abstract

BACKGROUND AND PURPOSE:The goal of aneurysm treatment is occlusion of an aneurysm without morbidity or mortality. Using well-established, traditional endovascular techniques, this is generally achievable with a high level of safety and efficacy. These techniques involve either constructive treatment of the aneurysm (coils with or without an intravascular stent) or deconstruction (coil occlusion) of the aneurysm and the parent artery. While established as safe and efficacious, the constructive treatment of large and giant aneurysms with coils has typically been associated with relatively lower rates of complete occlusion and higher rates of recurrence. Parent artery deconstruction, though immediately efficacious in achieving complete and durable occlusion, does require occlusion of a major intracranial blood vessel and is associated with risk of stroke.

Hydrogel versus Bare Platinum Coils in Patients with Large or Recurrent Aneurysms Prone to Recurrence after Endovascular Treatment: A Randomized Controlled Trial

“…[33][34][35][36] The PRET trial had several limitations. Operators could not be blinded to coil type.…”

Technology developments in endovascular treatment of intracranial aneurysms

“…This may be partially explained by the increased morbidity and mortality associated with the treatment of giant and complex aneurysms. Future studies, including the LARGE randomized clinical trial, which will compare endovascular coiling, stent assisted coiling, and flow diversion for large and giant aneurysms,74 are necessary and may help define the optimal treatment strategies for these patients.…”

Giant aneurysms: Still in the quest of a perfect cure

“…A randomized control trial is being carried out to compare the aneurysmal cure rate and its recurrence rate after traditional coiling and flow diversion. [23] FDs show promise as the simplest and probably the best endovascular modalities available at present; however, robust long-term results are still awaited to support their use in giant aneurysms.…”