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Purpose: The purpose of this study was to report the author’s experiences in treating large (10–25 mm) and giant (>25 mm) intracranialaneurysms (IAs) using a single Flow Re-direction Endoluminal Device (FRED) without assistant coiling, with a focus onprocedure-related complications. Materials and Methods: A total of 33 patients who were treated with FRED between January 2018 and July 2020 were retrospectivelyreviewed. The timing of procedure-related complications was chronologically categorized as acute (within 7 days), subacute(8 to 21 days), and delayed (after 21 days) periods. Follow-up angiography was performed at 2 to 27 months (mean 9.7months), and clinical follow-up was performed at 1 to 31 months (mean 14.1 months) in all patients. Results: Six (18.2%) patients experienced procedure-related complications, including 2 (6.1%) in acute period, 1 (3.0%) in subacuteperiod, and 3 (9.1%) in delayed period. Thromboembolic complications occurred in 5 (15.2%) patients and hemorrhagiccomplications in 1 (3.0%). Permanent morbidity and mortality rates were 3.0% each. Non-internal carotid artery (ICA) location ofIAs (odds ratio 6.532; 95% confidence interval, 1.335–17.816; p=0.034) was the only independent risk factor for procedure-relatedcomplications on multivariate logistic regression analysis. Conclusion: The procedure-related complication rate was 18.2% in this study. Procedure-related complications might increasewhen treating large and giant IAs located on a non-ICA, especially on the middle cerebral artery. Therefore, it may be suggestedthat neurointerventionists and endovascular neurosurgeons should pay attention to the location of IAs when treating large andgiant IAs with a single FRED.
