A multicenter study of 705 ruptured intracranial aneurysms treated with Guglielmi detachable coils

Abstract

Background and purpose: The long-term durability of Guglielmi detachable coil (GDC) embolization of cerebral aneurysms is still unknown. The purpose of this study was to evaluate the stability of anatomic occlusion of aneurysms treated with GDCs and assess the rate of recanalization and re-treatment.

Methods: A multicenter study involving 650 patients with 705 ruptured aneurysms treated with GDCs between January 1998 to May 2003 was conducted. During this period, 63% of ruptured aneurysms were treated by the endovascular technique. The morbidity and mortality associated with this technique, procedural feasibility, acute angiographic occlusion results, and long-term angiographic follow-up were assessed.

Results: Overall technical feasibility of GDC treatment was 96.9%. Upon admission, 25% of patients were Hunt and Hess grade IV or V. Acute angiographic results in 683 aneurysms demonstrated total occlusion in 496 cases (72.6%), subtotal occlusion in 171 cases (25.%), and incomplete occlusion in 16 cases (2.4%). All patients were controlled by angiography and MR imaging at 3 months, 1 year, and subsequent yearly examinations post-treatment. A second treatment was performed in 27 cases (recanalization, 4.7%). Long-term follow-up angiograms (mean, 36 months) were obtained in 571 aneurysms (95%). Of them, 422 aneurysms (73.9%) demonstrated complete occlusion, 148 aneurysms (25.9%) demonstrated subtotal occlusion, and only 1 aneurysm was incompletely occluded. Overall mortality was 11.4% for all patients, with procedural mortality evaluated at 1.4%. Overall morbidity was calculated at 8.6%. Only one rebleeding occurred in our study, with a second procedure performed without vital consequences for the patient.

Conclusion: Our multicenter study confirms the stability of aneurysm embolization with GDC, with only 4.7% of aneurysms requiring re-treatment.

Fig 1.

Location of ruptured aneurysms. ACA: Anterior Communicant Artery; MCA: Middle Cerebral Artery; ICA: Internal Carotid Artery; Pericallosal A: Pericallosal Artery; VBA: Vertebro Basilar Artery; PICA: Posterior Inferior Cerebellar Artery; PCA: Posterior Communicating Artery; Cerebellar A: Cerebellar Artery.

Fig 2.

Fisher and Hunt and Hess grades at admission.

Fig 3.

Sizes of aneurysms’ sac are indicated in millimeters. Numbers of aneurysms are reported.

Fig 4.

Relation between size of aneurysms and % of initial occlusion.

Fig 5.

[Table: see text] Hunt and Hess and Fisher grades of patient dead.