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Objective: We reviewed the treatment results of internal carotid artery (ICA) aneurysms with a maximum diameter of 10 mm or greater for the future selection of patients with indications for Pipeline Flex (Medtronic, Irvine, CA, USA). Methods: The treatment methods, treatment effects, complication rate, and retreatment rate were studied in lesions that were treated by coil embolization but are presently considered indications for treatment using Pipeline Flex among the 516 cerebral aneurysms treated at our hospital between July 2009 and May 2016. We also reviewed the literature concerning coil embolization for large and giant aneurysms and examined the results of coil embolization for aneurysms with indications for Pipeline. Results: The subjects were 10 patients consisting of 5 with asymptomatic unruptured aneurysm, 2 with symptomatic unruptured aneurysm, and 3 patients with recurrence after treatment for ruptured aneurysm. The mean size of the aneurysms was 12.8 mm (10.5–17.8 mm), and the mean follow-up period was 49.1 ± 13.4 months. The treatments were balloon-assisted coil embolization in eight patients and stent-assisted coil embolization in two patients. None showed postoperative symptomatic ischemic lesions, and the permanent morbidity was 0%. Of the two patients with symptomatic aneurysms, the symptoms were alleviated after treatment in one patient, and retreatment was necessary in one patient. In the review of the literature, comparisons were made in 69 large or giant aneurysms treated by coil embolization between those with and without indications for Pipeline. The additional treatment rate was significantly lower in the lesions with indications for Pipeline (33.3% vs. 61.9%, P = 0.02). The retreatment rate was significantly lower at 15.4%, particularly in extradural aneurysms (Bouthillier C4, 5). Conclusion: The results of this study suggest that the retreatment rate after conventional coil embolization for extradural unruptured large cerebral aneurysms was not high and that coil embolization is worth considering for asymptomatic aneurysms at these sites 10–15 mm in diameter.

Endovascular Embolization of Large Internal Carotid Artery Aneurysms: Single-center Experience with 10 Cases and Literature Review