Multiple intracranial aneurysms. Angiographic study and endovascular treatment

Abstract

We evaluate endovascular treatment (EVT) as an option to deal with multiple intracranial aneurysms(MA). From 1994 to 2001, 24 patients underwent EVT for 59 MA. Patients were followed- up clinically and angiographically in a period ranging from 6 to 93 months (mean time of 22.2) and from 4 to 69 months (mean time of 19.3), respectively. Ten patients (41.6%) were treated either by EVT (n=7, 29,16%) or by mixed treatment (EVT and surgery; n=3, 12.5%). Reasons for treating just ruptured aneurysms: six (25%) had aneurysms smaller than 5 mm; three (12.5%) deaths; two (8.33%) were in the subacute period; two (8.33%) lost to follow-up; one (4.17%) authorised no procedure. No rebleeding was detected at the clinical follow-up, but there were five deaths.At immediate arteriographic control: 28 (85%) aneurysms were fully occluded, four (12%) with neck flow and one (03%) with sac flow. For 20 aneurysms followed-up: stability of occlusion was reached in seven cases (35%) and repermeabilization in 13 (65%). Management of recanalization was close arteriography in seven (54%), re-embolization in five (38%) and surgery in one (08%). When treating MA, EVT is advisable either alone or in mixed therapy. As a high degree of repermeabilization was disclosed, strict arteriographic control is required. The mechanisms underlying aneurysmal formation may be also involved in the recanalization phenomenon , a possible new manifestation of the fragility of the arterial wall.

Graph 1

General vision of the population studied

Figure 1

Embolization of two aneurysms of the supraclinoid segment of left (A) and right internal carotid artery during different procedures (B). For both we used DCS, firstly choosing J-shaped coils for internal remodelling (C,D) and then we had put inside this cage spiral-shaped ones intending to have a dense packing (E,F).

Figure 1

Embolization of two aneurysms of the supraclinoid segment of left (A) and right internal carotid artery during different procedures (B). For both we used DCS, firstly choosing J-shaped coils for internal remodelling (C,D) and then we had put inside this cage spiral-shaped ones intending to have a dense packing (E,F).

Figure 2

Embolization of an aneurysm at A1-A2 segment of left anterior cerebral artery (A) and another at the trifurcation of the left middle cerebral artery during the same session (B), using DCS spiral shaped coils (C,D).

Figure 3

A case of full repermeabilization of mirror aneurysms of middle cerebral artery (A,B), whose therapeuthic option was EVT in different sessions (C,D).