Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients

View More View Less
  • 1 Department of Radiology, University of California at Los Angeles, Los Angeles, California; and Department of Radiology, The Methodist Hospital, Houston, Texas
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

✓ From December 1990 to July 1995, the investigators participated in a prospective clinical study to evaluate the safety of the Guglielmi detachable coil (GDC) system for the treatment of aneurysms. This report summarizes the perioperative results from eight initial interventional neuroradiology centers in the United States. The report focuses on 403 patients who presented with acute subarachnoid hemorrhage from a ruptured intracranial aneurysm. These patients were treated within 15 days of the primary intracranial hemorrhage and were followed until they were discharged from the hospital or died.

Seventy percent of the patients were female and 30% were male. The patients' mean age was 58 years old. Aneurysm size was categorized as small (60.8%), large (34.7%), and giant (4.5%); and neck size was categorized as small (53.6%), wide (36.2%), fusiform (6%), and undetermined (4.2%). Fifty-seven percent of the aneurysms were located in the posterior circulation and 43% in the anterior circulation.

Eighty-two patients were classified as Hunt and Hess Grade I (20.3%), 105 Grade II (26.1%), 121 Grade III (30%), 69 Grade IV (17.1%), and 26 Grade V (6.5%). All patients in this study were excluded from surgical treatment either because of anticipated surgical difficulty (69.2%), attempted and failed surgery (12.7%), the patient's poor neurological (12.2%) or medical (4.7%) status, and/or refusal of surgery (1.2%).

The GDC embolization was performed within 48 hours of primary hemorrhage in 147 patients (36.5%), within 3 to 6 days in 156 patients (38.7%), 7 to 10 days in 71 patients (17.6%), and 11 to 15 days in 29 patients (7.2%). Complete aneurysm occlusion was observed in 70.8% of small aneurysms with a small neck, 35% of large aneurysms, and 50% of giant aneurysms. A small neck remnant was observed in 21.4% of small aneurysms with a small neck, 57.1% of large aneurysms, and 50% of giant aneurysms. Technical complications included aneurysm perforation (2.7%), unintentional parent artery occlusion (3%), and untoward cerebral embolization (2.48%). There was a 8.9% immediate morbidity rate related to the GDC technique. Seven deaths were related to technical complications (1.74%) and 18 (4.47%) to the severity of the primary hemorrhage.

The findings of this study demonstrate the safety of the GDC system for the treatment of ruptured intracranial aneurysms in anterior and posterior circulations. The authors believe additional randomized studies will further identify the role of this technique in the management of acutely ruptured incranial aneurysms.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Fernando Viñuela, M.D., Department of Radiology, University of California at Los Angeles, 10833 Le Conte Avenue, Los Angeles, California 90095–1721.
  • 1.

    Batjer H, & Samson D: Intraoperative aneurysmal rupture: incidence, outcome and suggestions for surgical management. Neurosurgery 18:701707, 1986 Batjer H, Samson D: Intraoperative aneurysmal rupture: incidence, outcome and suggestions for surgical management. Neurosurgery 18:701–707, 1986

    • Search Google Scholar
    • Export Citation
  • 2.

    Berenstein A, , Ransohoff J, & Kupersmith M, et al: Transvascular treatment of giant aneurysms of the cavernous carotid and vertebral arteries. Functional investigation and embolization. Surg Neurol 21:312, 1984 Berenstein A, Ransohoff J, Kupersmith M, et al: Transvascular treatment of giant aneurysms of the cavernous carotid and vertebral arteries. Functional investigation and embolization. Surg Neurol 21:3–12, 1984

    • Search Google Scholar
    • Export Citation
  • 3.

    Casasco A, , Lylyk P, & Hodes JE, et al: Percutaneous transvenous catheterization and embolization of vein of Galen aneurysms. Neurosurgery 28:260266, 1991 Casasco A, Lylyk P, Hodes JE, et al: Percutaneous transvenous catheterization and embolization of vein of Galen aneurysms. Neurosurgery 28:260–266, 1991

    • Search Google Scholar
    • Export Citation
  • 4.

    Chyatte D, , Fode NC, & Sundt TM Jr: Early versus late intracranial aneurysm surgery in subarachnoid hemorrhage. J Neurosurg 69:326331, 1988 Chyatte D, Fode NC, Sundt TM Jr: Early versus late intracranial aneurysm surgery in subarachnoid hemorrhage. J Neurosurg 69:326–331, 1988

    • Search Google Scholar
    • Export Citation
  • 5.

    Disney L, , Weir B, & Petruk K: Effect on management mortality of a deliberate policy of early operation on supratentorial aneurysms. Neurosurgery 20:695701, 1987 Disney L, Weir B, Petruk K: Effect on management mortality of a deliberate policy of early operation on supratentorial aneurysms. Neurosurgery 20:695–701, 1987

    • Search Google Scholar
    • Export Citation
  • 6.

    Drake CG: Management of cerebral aneurysm. Stroke 12:273283, 1981 Drake CG: Management of cerebral aneurysm. Stroke 12:273–283, 1981

    • Search Google Scholar
    • Export Citation
  • 7.

    Fox AJ, , Viñuela F, & Pelz DM, et al: Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms. J Neurosurg 66:4046, 1987 Fox AJ, Viñuela F, Pelz DM, et al: Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms. J Neurosurg 66:40–46, 1987

    • Search Google Scholar
    • Export Citation
  • 8.

    Gilsbach JM, & Harders AG: Morbidity and mortality after early aneurysm surgery—a prospective study with nimodipine prevention. Acta Neurochir 96:17, 1989 Gilsbach JM, Harders AG: Morbidity and mortality after early aneurysm surgery—a prospective study with nimodipine prevention. Acta Neurochir 96:1–7, 1989

    • Search Google Scholar
    • Export Citation
  • 9.

    Guglielmi G, , Viñuela F, & Dion J, et al: Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. J Neurosurg 75:814, 1991 Guglielmi G, Viñuela F, Dion J, et al: Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. J Neurosurg 75:8–14, 1991

    • Search Google Scholar
    • Export Citation
  • 10.

    Guglielmi G, , Viñuela F, & Duckwiler G, et al: Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg 77:515524, 1992 Guglielmi G, Viñuela F, Duckwiler G, et al: Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg 77:515–524, 1992

    • Search Google Scholar
    • Export Citation
  • 11.

    Hernesniemi J, , Vapalahti M, & Niskanen M, et al: Management outcome for vertebrobasilar artery aneurysms by early surgery. Neurosurgery 31:857862, 1992 Hernesniemi J, Vapalahti M, Niskanen M, et al: Management outcome for vertebrobasilar artery aneurysms by early surgery. Neurosurgery 31:857–862, 1992

    • Search Google Scholar
    • Export Citation
  • 12.

    Higashida RT, , Halbach VV, & Barnwell SL: Treatment of intracranial aneurysms with preservation of the parent vessel: results of percutaneous balloon embolization in 84 patients. AJNR 11:633640, 1990 Higashida RT, Halbach VV, Barnwell SL: Treatment of intracranial aneurysms with preservation of the parent vessel: results of percutaneous balloon embolization in 84 patients. AJNR 11:633–640, 1990

    • Search Google Scholar
    • Export Citation
  • 13.

    Jane JA, , Winn HR, & Richardson AE: The natural history of intracranial aneurysms: rebleeding rates during the acute and long term period and implications for surgical management. Clin Neurosurg 24:176184, 1977 Jane JA, Winn HR, Richardson AE: The natural history of intracranial aneurysms: rebleeding rates during the acute and long term period and implications for surgical management. Clin Neurosurg 24:176–184, 1977

    • Search Google Scholar
    • Export Citation
  • 14.

    Jomin M, , Lesoin F, & Lozes G: Prognosis with 500 ruptured and operated intracranial arterial aneurysms. Surg Neurol 21:1318, 1984 Jomin M, Lesoin F, Lozes G: Prognosis with 500 ruptured and operated intracranial arterial aneurysms. Surg Neurol 21:13–18, 1984

    • Search Google Scholar
    • Export Citation
  • 15.

    Juvela S: Rebleeding from ruptured intracranial aneurysms. Surg Neurol 32:323326, 1989 Juvela S: Rebleeding from ruptured intracranial aneurysms. Surg Neurol 32:323–326, 1989

    • Search Google Scholar
    • Export Citation
  • 16.

    Kassell NF, , Torner JC, & Jane JA, et al: The International Cooperative Study on the timing of aneurysm surgery. Part 2: Surgical results. J Neurosurg 73:3747, 1990 Kassell NF, Torner JC, Jane JA, et al: The International Cooperative Study on the timing of aneurysm surgery. Part 2: Surgical results. J Neurosurg 73:37–47, 1990

    • Search Google Scholar
    • Export Citation
  • 17.

    Ljunggren B, , Brandt L, & Säveland H, et al: Management of ruptured intracranial aneurysms: a review. Br J Neurosurg 1:932, 1987 Ljunggren B, Brandt L, Säveland H, et al: Management of ruptured intracranial aneurysms: a review. Br J Neurosurg 1:9–32, 1987

    • Search Google Scholar
    • Export Citation
  • 18.

    Ljunggren B, , Säveland H, & Brandt L, et al: Aneurysmal subarachnoid hemorrhage. Total annual outcome in a 1.46 million population. Surg Neurol 22:435438, 1984 Ljunggren B, Säveland H, Brandt L, et al: Aneurysmal subarachnoid hemorrhage. Total annual outcome in a 1.46 million population. Surg Neurol 22:435–438, 1984

    • Search Google Scholar
    • Export Citation
  • 19.

    Lougheed WM: Selection, timing and technique of aneurysm surgery of the anterior circle of Willis. Clin Neurosurg 16:95113, 1969 Lougheed WM: Selection, timing and technique of aneurysm surgery of the anterior circle of Willis. Clin Neurosurg 16:95–113, 1969

    • Search Google Scholar
    • Export Citation
  • 20.

    Mandai S, , Kinugasa K, & Ohmoto T: Direct thrombosis of aneurysms with cellulose acetate polymer. Part I: Results of thrombosis in experimental aneurysms. J Neurosurg 77:497500, 1992 Mandai S, Kinugasa K, Ohmoto T: Direct thrombosis of aneurysms with cellulose acetate polymer. Part I: Results of thrombosis in experimental aneurysms. J Neurosurg 77:497–500, 1992

    • Search Google Scholar
    • Export Citation
  • 21.

    Saito I, , Ueda Y, & Sano K: Significance of vasospasm in the treatment of ruptured intracranial aneurysms. J Neurosurg 47:412429, 1977 Saito I, Ueda Y, Sano K: Significance of vasospasm in the treatment of ruptured intracranial aneurysms. J Neurosurg 47:412–429, 1977

    • Search Google Scholar
    • Export Citation
  • 22.

    Säveland H, , Hillman J, & Brandt L, et al: Overall outcome in aneurysmal subarachnoid hemorrhage. A prospective study from neurosurgical units in Sweden during a 1-year period. J Neurosurg 76:729734, 1992 Säveland H, Hillman J, Brandt L, et al: Overall outcome in aneurysmal subarachnoid hemorrhage. A prospective study from neurosurgical units in Sweden during a 1-year period. J Neurosurg 76:729–734, 1992

    • Search Google Scholar
    • Export Citation
  • 23.

    Seiler RW, , Reulen HJ, & Huber P, et al: Outcome of aneurysmal subarachnoid hemorrhage in a hospital population: a prospective study including early operation, intravenous nimodipine and transcranial doppler ultrasound. Neurosurgery 23:598604, 1988 Seiler RW, Reulen HJ, Huber P, et al: Outcome of aneurysmal subarachnoid hemorrhage in a hospital population: a prospective study including early operation, intravenous nimodipine and transcranial doppler ultrasound. Neurosurgery 23:598–604, 1988

    • Search Google Scholar
    • Export Citation
  • 24.

    Sundt TM Jr: Cerebral vasospasm following subarachnoid hemorrhage: evolution, management and relationship to timing of surgery. Clin Neurosurg 24:228239, 1977 Sundt TM Jr: Cerebral vasospasm following subarachnoid hemorrhage: evolution, management and relationship to timing of surgery. Clin Neurosurg 24:228–239, 1977

    • Search Google Scholar
    • Export Citation
  • 25.

    Taneda M: Effect of early operation for ruptured aneurysms on prevention of delayed ischemic symptoms. J Neurosurg 57:622628, 1982 Taneda M: Effect of early operation for ruptured aneurysms on prevention of delayed ischemic symptoms. J Neurosurg 57:622–628, 1982

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 641 233 21
Full Text Views 249 18 1
PDF Downloads 124 17 1
EPUB Downloads 0 0 0