Endovascular treatment of posterior circulation cerebral aneurysms by using Guglielmi detachable coils: a 10-year single-center experience with special regard to technical development

Abstract

Background and purpose: The purpose of this study was to analyze the immediate and long-term angiographic and clinical results of endovascular treatment of posterior circulation aneurysms with special regard to technical development.

Materials: Between 1993 and 2003, 46 patients with 47 aneurysms of the posterior circulation were referred to our institution for endovascular treatment. Mean angiographic follow-up was 1.7 years. Clinical follow-up was determined at hospital discharge and by using a questionnaire for long-term follow-up (mean, 3.3 years). To analyze technical development, patients treated before (group 1) and after (group 2) implementation of 3D Guglielmi detachable coils (3D GDCs) in 1999 were compared. Multivariate analysis was performed to determine factors predictive of clinical and technical outcome.

Results: Overall, at initial treatment complete occlusion was achieved in 27 (57.4%) aneurysms, a neck remnant was present in 16 (34.0%) aneurysms, incomplete occlusion was achieved in 3 (6.4%) aneurysms, and in 1 (2.1%) case occlusion was not attempted. Procedure-related permanent morbidity was 4.3%, and the mortality rate was 0%. There was no rebleeding of treated aneurysms. Complete occlusion at initial treatment (P = .003) and recanalization rate (P = .008) correlated with aneurysm sac size. A statistically significant relationship between Hunt and Hess/World Federation of Neurologic Surgeons clinical grading scale score and clinical outcome (Glasgow Outcome Score) was found (P < .05). Subgroup analysis revealed that a higher initial obliteration rate of larger aneurysms was achieved in group 2 (3D GDC, 22 patients, 22 aneurysms) than in group 1 (23 patients, 24 aneurysms; P = .03). At angiographic follow-up, overall recanalization was 47.1% in group 2 and 47.6% in group 1. Aneurysm neck size was not found to be correlated with occlusion and recanalization rate.

Conclusion: In our series, GDC technology was an effective and safe technique for the treatment of posterior circulation aneurysms. Aneurysm sac size was predictive for occlusion rate and the Hunt and Hess/World Federation of Neurologic Surgeons grade for clinical outcome. The introduction of 3D GDCs into our practice significantly improved the initial occlusion rate but did not affect the incidence of recanalization.

Fig 1.

Percentage of aneurysms occlusion rate according to sac size at completion of the initial embolization. Bars represent sac size: black < 7 mm; gray = 7–12 mm; white > 12 mm.

Fig 2.

Percentage of aneurysms occlusion rate according to sac size at final angiographic follow-up. Bars represent sac size: black < 7 mm; gray = 7–12 mm; white > 12 mm.

Fig 3.

Aneurysm morphology by group. A, Percentage of aneurysm occlusion rate according to sac size at completion of the initial embolization in the early group before the introduction of 3D GDCs. B, Percentage of aneurysm occlusion rate according to sac size at completion of the initial embolization in the early group after the introduction of 3D GDCs.

Fig 4.

Percentage of aneurysm occlusion rate for aneurysms >7 mm at completion of the initial embolization in the early group before the introduction of 3D GDC (group 1) and in the group after the introduction of 3D GDC (group 2).