Clinical and radiogical outcomes of endovascular detachable coil embolization in paraclinoid aneurysms : a 10-year experience

Abstract

Objective: Direct surgical clipping of paraclinoid aneurysms poses technical challenges to even very experienced neurosurgeons, making endovascular treatment an alternative treatment modality in many centers. We have therefore retrospectively evaluated the safety and efficacy of endovascular detachable coil embolization of paraclinoid aneurysms.

Methods: From June 1997 to June 2007, 65 patients underwent endovascular detachable coiling for 67 paraclinoid aneurysms (of which 9 were ruptured and 58 were unruptured) in our institute. Their medical records, radiological images and readings, and operation records were reviewed retrospectively.

Results: After the initial embolization procedure, complete occlusion was achieved in 29 (43.3%) of the aneurysms treated by endovascular detachable coiling. Six aneurysms required retreatment, with two each requiring one, two, or three additional endovascular procedures. Fifty-five (82.1%) aneurysms were measured by three-dimensional time of flight (TOF) magnetic resonance images (MRI) or transfemoral cerebral angiography (TFCA) at a mean follow-up of 29.7 months (range from 4 to 94 months), with 39 aneurysms (70.9%) showing complete occlusion. Thromboembolic events (3.8%) were the most frequent complication. Rupture did not occur during or after any of the procedures. According to the Glasgow Outcome Scale (GOS), 98.4% of the patients treated by coil embolization had a score of 4 or 5.

Conclusion: Our results indicate that endovascular detachable coiling is a safe and effective treatment modality in paraclinoid aneurysms.

Keywords: Aneurysms; Endovascular; Paraclinoid.

Fig. 1

Preoperative anteroposterior (A) and lateral (B) right carotid artery (CA) angiogram, revealing a dorsal wall aneurysm arising from the distal portion of the ophthalmic artery. Final lateral angiogram (C) after detachable coil embolization confirmed a small residual neck of the aneurysm. About 6 months later, follow-up 3D time of flight (TOF) magnetic resonance images (MRI) (D) shows that the small residual neck of the dorsal wall aneurysm is suspicious. Post-embolization 3D TOF MRI (E) taken one-and-half year later shows no definite residual sac. Post-embolization magnetic resonance angiography (F) performed at two-and-half year later confirms no definite residual sac or neck.