Endovascular Treatment of Cerebral Aneurysms with Guglielmi Detachable Coils: Retrospective Review of a 4-Year Experience.

Ko, Jun Kyeung; Choi, Chang Hwa; Lee, Tae Hong; Baik, Seung Kug

Original Article

Journal of Korean Neurosurgical Society 2003;34(5): 419-427.

Jun Kyeung Ko, Chang Hwa Choi, Tae Hong Lee, Seung Kug Baik

¹Department of Neurosurgery, Busan National University College of Medicine, Busan, Korea. chwachoi@pusan.ac.kr
²Department of Diagnostic Radiology, Busan National University College of Medicine, Busan, Korea.
³Department of Diagnostic Radiology, Keimyung University College of Medicine, Daegu, Korea.

ABSTRACT

OBJECTIVE
The authors evaluate the usefulness, results, and technical problem of endovascular treatment of cerebral aneurysms with Guglielmi detachable coil(GDC). METHODS: Forty patients with 31 ruptured and 11 unruptured aneurysms were treated with GDC embolization. Twenty-four aneurysms were located in the anterior circulation and 18 in the posterior circulation. Aneurysms size was categorized small(n=31) or large(n=11) and neck size was categorized narrow(n=30) or wide(n=12). We statistically analyzed occlusion rate according to the location, rupture, size, and neck size of aneurysms, and investigated the procedure-related complications and clinical outcomes.
RESULTS
GDC treatment of aneursyms was successful in 40 aneurysms of 39 patients(95.2%). Total occlusion was achieved in 24(60.0%) cases, subtotal occlusion in 12(30%), and incomplete occlusion in 4(10.0%). Each total occlusion rate was 69.0% in small-sized, 36.4% in large-sized, 69.0% in narrow-necked, and 36.4% in wide-necked aneurysms. Location and rupture of aneurysms did not influence occlusion rate. The technical complications included 4 thromboembolisms, 3 parent artery occlusions, and 1 perforation of aneurysm. Procedure-related morbidity and mortality were 10.3% and 2.6%. 3 subtotally or incompletely embolized aneurysms in posterior circulation rebled during the follow-up period. CONCLUSION: The results of this study indicate that endovascular GDC treatment is an appropriate therapeutic alternative in cerebral aneurysms. However, the rebleeding by aneurysmal recanalization or regrowth is a major limitation of GDC treatment. Follow-up angiography and further technical improvement are mandatory to overcome rebleeding.

Key Words: Cerebral aneurysm; Endovascular treatment; Detachable coil; Complication; Rebleeding