Large and giant intracranial aneurysms: outcomes from the multicenter prospective SMART coils registry
Year: 2026
Type: article
Abstract: Background Endovascular coiling for intracerebral aneurysms has been evolving. Yet, large and giant aneurysms (LAGA) remain a significant challenge in any treatment modality and carry high rates of morbidity and mortality. Method The SMART registry, a prospective, multicenter site-adjudicated trial, was used to identify patients with LAGA (Sac 10–25 mm for large and >25 mm for giant) treated with the Penumbra SMART COIL (SMART) system and compare their outcomes to patients with smaller aneurysms (SA; Sac ≤ 10 mm). Aneurysm occlusion per Raymond-Roy (RROC) scale, recanalization, retreatment, mortality, and serious device-related adverse events (SAEs) were analyzed. Results A total of 133/905 (14.7%) enrolled patients had LAGA with a mean (SD) aneurysm size of 13.7 (3.59) mm for LAGA and 5.8 (1.95) mm for SA. LAGA were more likely to be non-saccular (24.1% vs. 12.3%, p = 0.0007) and wide-necked (69.9% vs. 59.7%, p = 0.0268) compared to SA. Primary coiling was the main treatment modality for LAGA and SA (43.6% vs. 43.3%; p = 1.0). However, LAGA were more likely to be treated with flow diversion in addition to coiling (6.0% vs. 1.0%, p < 0.001). At 1-year follow-up: (i) RROC I-II was 82.7% in LAGA and 91.2% in SA; p = 0.0166, (ii) recanalization rates were 13.8% vs. 12.7%; p = 0.7417, and retreatment rates were 11.5% vs. 6.4%; p = 0.0648, for LAGA and SA, respectively, and (iii) all-cause mortality was 9.8% in LAGA vs. 4.7% SA; p = 0.0222. The device-related SAEs rates were low and comparable between the two study groups (4.5% vs. 4.1%; p = 0.8153). Conclusion The SMART registry demonstrated that endovascular coiling can be feasible and safe in patients with LAGA, however randomized controlled studies are needed for comparative effectiveness. Clinical trial registration https://clinicaltrials.gov/study/NCT02729740 .
Source: Frontiers in Neurology
Authors: Yazan Ashouri, Alexandra R. Paul, Mohammad AlMajali, Amit Chaudhari, Eugene Lin, Min S. Park, Richard J. Bellon, Bradley N. Bohnstedt, Albert J. Yoo, Clemens M. Schirmer, Reade A. DeLeacy, David J. Fiorella, Keith Woodward, Harris E. Hawk, Ashish Nanda, Peter J. Sunenshine, Mouhammed R. Kabbani, Kenneth V. Snyder, Thinesh Sivapatham, Travis M. Dumont, Alan R. Reeves, Robert M. Starke, Alejandro M. Spiotta, Osama O. Zaidat
Institutions: Albany Medical Center Hospital, University of Virginia Health System, University of Virginia, Indiana University Health, Geisinger Medical Center, Mount Sinai Hospital, Mount Sinai Hospital, Mount Sinai Hospital, Mount Sinai Hospital, Stony Brook University Hospital, Fort Sanders Regional Medical Center, Erlanger Health System, Banner - University Medical Center Phoenix, Gundersen Health System, University at Buffalo, State University of New York, Christiana Care Health System, University of Arizona, University of Kansas, University of Miami Hospital, Medical University of South Carolina
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
Funders: Neurosurgery Research and Education Foundation, Stryker, Joe Niekro Foundation, Penumbra, National Institutes of Health, National Institute of Neurological Disorders and Stroke, National Center for Advancing Translational Sciences, National Institute on Minority Health and Health Disparities
OpenAlex ID: W7124180411