Endovascular Treatment with GDC for Severe Acute SAH: Comparison with Early Direct Surgery

Abstract

The purpose of this study was to evaluate the effect of endovascular treatment with Guglielmi detachable coils (GDC) on the outcome of severe subarachnoid hemorrhage (SAH) caused by acute rupture of a cerebral aneurysm and on the incidence of symptomatic vasospasm. Thirty- five patients with aneurysmal SAH were treated in the acute stage using GDC. Fifteen out of 17 patients in Hunt & Kosnik grades I, II, and III showed good recovery (GR) at discharge, while one was moderately disabled (MD) and one was severely disabled (SD). Among 16 patients in poor neurological condition (GCS was </= 9 on admission), the outcome was GR in 5 cases (31%), MD in 2 (13%), and SD in 9 (56%). These results were better than those for surgically treated patients with the same neurological status. The difference in outcome between endovascular treatment and surgery may have been related to the difference in the insult to the brain caused by each modality. The incidence of symptomatic vasospasm was lower in the GDC group (5.7%) than in the surgical group (12%). In the patients treated with GDC and intrathecal administration of urokinase, subarachnoid clots were cleared more rapidly than in those treated surgically with continuous cisternal irrigation. The accelerated clearance of subarachnoid clots in the GDC group might have helped to prevent delayed vasospasm. The long-term efficacy of GDC embolization in preventing subsequent bleeding has not yet been determined. However, this method seems to be less traumatic for the brain and may be suitable for treatment of patients with severe SAH.

Figure 1

Outcome of severe SAH patients (GCS ≤ 9).

Figure 2

Incidence of symptomatic vasospasm in the surgically treated cases and GDC cases.

Figure 3

Serial changes of Hounsfield number of basal cistern in GDC treated cases and surgical cases.

Figure 4

Serial changes of Hounsfield number of basal cistern in the GDC treated cases with/without intrathecal administration of urokinase and in the surgically treated cases.