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Yuichi Murayama, Fernando Viñuela, Gary R. Duckwiler, Y. Pierre Gobin, and Guido Guglielmi

Guglielmi detachable coil (GDC) technology is a valuable therapeutic alternative to the surgical treatment of ruptured or incidental intracranial aneurysms. The authors describe their technical and clinical experience in the utilization of the GDC technique in patients who underwent endovascular occlusion for the treatment of incidentally found intracranial aneurysms.

One hundred fifteen patients with 120 incidentally found intracranial aneurysms underwent embolization using the GDC endovascular technique. Ninety-one patients were female and 24 were male. Patient age ranged from 13 to 80 years. In 64 patients the incidental aneurysms were discovered when unrelated nonneurological conditions indicated the need for angiography or magnetic resonance angiography (Group 1). Twenty patients who presented with incidental aneurysms that were discovered during treatment for an acutely ruptured aneurysm were treated in the acute phase of subarachnoid hemorrhage (SAH) (Group 2). Sixteen patients with incidental aneurysms were treated during the chronic phase of SAH (Group 3). Group 4 included 15 patients who had incidental aneurysms associated with brain tumors or arteriovenous malformations.

Angiographic results showed complete or near complete occlusion in 109 aneurysms (91%) and incomplete occlusion in five aneurysms (4%). Unsuccessful GDC embolization was attempted in six aneurysms (5%). One hundred nine patients (94.8%) remained neurologically intact or unchanged from initial clinical status. Five patients (4.3%) deteriorated due to immediate procedural complications (overall immediate morbidity rate). All of these complications occurred in the first 50 patients treated earlier in this series. No clinical complications were observed in the last 65 patients. Follow-up cerebral angiograms were obtained in 77 patients with 79 aneurysms. The median clinical follow-up period was 16.3 months.

No recanalization was observed in the 52 completely occluded aneurysms. Of the 22 aneurysms with small neck remnants, eight (36%) showed further thrombosis, 7 (32%) remained anatomically unchanged, and seven (32%) showed recanalization due to compaction of the coils. In one patient, a partially embolized aneurysm ruptured 3 years postembolization. In Groups 1 and 3, the average length of hospitalization was 3.3 days.

The evolution of the GDC technology has proved to provide safe treatment of incidental aneurysms (a morbidity rate of 0% was achieved in the last 65 patients). The topography of the aneurysm and the clinical condition of the patient did not influence final anatomical or clinical outcomes. The GDC technology also confers a positive economical impact by decreasing hospital length of stay and by eliminating the need for postembolization intensive care unit care.

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Kristen Upchurch, Lei Feng, Gary R. Duckwiler, John G. Frazee, Neil A. Martin, and Fernando Viñuela

✓ Nongalenic cerebral arteriovenous fistulas (AVFs) are uncommon, high-flow vascular lesions first treated by Walter Dandy and his colleagues by using open surgery with ligation of the feeding artery. Due to advances in endovascular technology over the past four decades that make possible the control of high flow in AVFs, treatment has evolved from the sole option of surgery to include the alternative or adjunct option of endovascular embolization. The authors of this review discuss the history of nongalenic AVF treatment, including techniques of both surgery and interventional neuroradiology and the technological developments underlying them.