Object. The authors report on important factors that influenced clinical and angiographically demonstrated outcomes in patients treated using coil embolization.
Methods. This study included 160 consecutive patients who underwent endovascular coil embolization for treatment of intracranial aneurysms. Univariate and multivariate logistic regression analyses were performed to assess factors that influenced the immediate posttreatment angiographic result. Cox regression analysis was used to establish factors related to the occurrence of negative events as well as a curve indicating the time to a negative event. Negative events were defined as aneurysm remnant increase, repeated treatment, rebleeding, or death during periprocedural hospitalization.
Seventy-three percent of the patients treated in this study were independent or demonstrated no deficit (Glasgow Outcome Scale [GOS] Score 4 or 5) at a mean follow up of 18.2 months. The annual delayed rebleeding rate was 0.45%. Fifty percent of patients (65 of 131) suffered a negative event within 13 ± 14 months (standard deviation). Statistically significant factors associated with the occurrence of negative events were rupture status (p = 0.0128) and immediate posttreatment angiographic result (p < 0.001). Overall clinical outcome assessed using the GOS was significantly related to the immediate posttreatment angiographic result (χ2 = 4.788, p = 0.029). The immediate posttreatment angiographic results were significantly influenced by catheter stability (p = 0.0012), aneurysm geometry (that is, simple or complex, p = 0.0053), and aneurysm neck diameter (p = 0.0205).
Conclusions. A good or excellent clinical outcome can be obtained in most patients treated using endovascular coil embolization of intracranial aneurysms. Note, however, that a significant number of patients treated using traditional platinum coils will harbor unstable aneurysm remnants or require repeated treatment.
Baxter BW, , Rosso D, & Lownie SP: Double microcatheter technique for detachable coil treatment of large, wide-necked intracranial aneurysms. AJNR 19:1176–1178, 1998 Baxter BW, Rosso D, Lownie SP: Double microcatheter technique for detachable coil treatment of large, wide-necked intracranial aneurysms. AJNR 19:1176–1178, 1998
Debrun GM, , Aletich VA, , Kehrli P, , Misra M, , Ausman JI, & Charbel F: Selection of cerebral aneurysms for treatment using Guglielmi detachable coils: the preliminary University of Illinois at Chicago experience. Neurosurgery 43:1281–1297, 1998 Debrun GM, Aletich VA, Kehrli P, Misra M, Ausman JI, Charbel F: Selection of cerebral aneurysms for treatment using Guglielmi detachable coils: the preliminary University of Illinois at Chicago experience. Neurosurgery 43:1281–1297, 1998
Fernandez Zubillaga A, , Guglielmi G, , Viñuela F, & Duckwiler GR: Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. AJNR 15:815–820, 1994 Fernandez Zubillaga A, Guglielmi G, Viñuela F, Duckwiler GR: Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. AJNR 15:815–820, 1994
Gonzalez N, , Murayama Y, , Nien YL, , Martin N, , Frazee J, & Duckwiler G, et al: Treatment of unruptured aneurysms with GDCs: clinical experience with 247 aneurysms. AJNR 25:577–583, 2004 Gonzalez N, Murayama Y, Nien YL, Martin N, Frazee J, Duckwiler G, et al: Treatment of unruptured aneurysms with GDCs: clinical experience with 247 aneurysms. AJNR 25:577–583, 2004
Hayakawa M, , Murayama Y, , Duckwiler GR, , Gobin YP, , Guglielmi G, & Viñuela F: Natural history of the neck remnant of a cerebral aneurysm treated with the Guglielmi detachable coil system. J Neurosurg 93:561–568, 2000 Hayakawa M, Murayama Y, Duckwiler GR, Gobin YP, Guglielmi G, Viñuela F: Natural history of the neck remnant of a cerebral aneurysm treated with the Guglielmi detachable coil system. J Neurosurg 93:561–568, 2000
Hunt WE, & Hess RM: Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–20, 1968 Hunt WE, Hess RM: Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–20, 1968
International Study of Unruptured Intracranial Aneurysms Investigators: Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362:103–110, 2003 International Study of Unruptured Intracranial Aneurysms Investigators: Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362:103–110, 2003
International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group: International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized trial. Lancet 360:1267–1274, 2002 International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group: International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized trial. Lancet 360:1267–1274, 2002
Jennett B, & Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480–484, 1975 Jennett B, Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480–484, 1975
Johnston SC, , Higashida RT, , Barrow DL, , Caplan LR, , Dion JE, & Hademenos G, et al: Recommendations for the endovascular treatment of intracranial aneurysms: a statement for healthcare professionals from the Committee on Cerebrovascular Imaging of the American Heart Association Council on Cardiovascular Radiology. Stroke 33:2536–2544, 2002 Johnston SC, Higashida RT, Barrow DL, Caplan LR, Dion JE, Hademenos G, et al: Recommendations for the endovascular treatment of intracranial aneurysms: a statement for healthcare professionals from the Committee on Cerebrovascular Imaging of the American Heart Association Council on Cardiovascular Radiology. Stroke 33:2536–2544, 2002
Juvela S: Natural history of unruptured intracranial aneurysms: risks for aneurysm formation, growth, and rupture. Acta Neurochir Suppl 82:27–30, 2002 Juvela S: Natural history of unruptured intracranial aneurysms: risks for aneurysm formation, growth, and rupture. Acta Neurochir Suppl 82:27–30, 2002
Juvela S, , Poussa K, & Porras M: Factors affecting formation and growth of intracranial aneurysms: a long-term follow-up study. Stroke 32:485–491, 2001 Juvela S, Poussa K, Porras M: Factors affecting formation and growth of intracranial aneurysms: a long-term follow-up study. Stroke 32:485–491, 2001
Juvela S, , Porras M, & Poussa K: Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture. J Neurosurg 93:379–387, 2000 Juvela S, Porras M, Poussa K: Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture. J Neurosurg 93:379–387, 2000
Kawanabe Y, , Sadato A, , Taki W, & Hashimoto N: Endovascular occlusion of intracranial aneurysms with Guglielmi detachable coils: correlation between coil packing density and coil compaction. Acta Neurochir 143:451–455, 2001 Kawanabe Y, Sadato A, Taki W, Hashimoto N: Endovascular occlusion of intracranial aneurysms with Guglielmi detachable coils: correlation between coil packing density and coil compaction. Acta Neurochir 143:451–455, 2001
Lin T, , Fox AJ, & Drake CG: Regrowth of aneurysm sacs from residual neck following aneurysm clipping. J Neurosurg 70:556–560, 1989 Lin T, Fox AJ, Drake CG: Regrowth of aneurysm sacs from residual neck following aneurysm clipping. J Neurosurg 70:556–560, 1989
Murayama Y, , Nien YL, , Duckwiler G, , Gobin YP, , Jahan R, & Frazee J, et al: Guglielmi detachable coil embolization of cerebral aneurysms: 11 years' experience. J Neurosurg 98:959–966, 2003 Murayama Y, Nien YL, Duckwiler G, Gobin YP, Jahan R, Frazee J, et al: Guglielmi detachable coil embolization of cerebral aneurysms: 11 years' experience. J Neurosurg 98:959–966, 2003
Murayama Y, , Viñuela F, , Tateshima S, , Song JK, , Gonzalez NR, & Wallace MP: Bioabsorbable polymeric material coils for embolization of intracranial aneurysms: a preliminary experimental study. J Neurosurg 94:454–463, 2001 Murayama Y, Viñuela F, Tateshima S, Song JK, Gonzalez NR, Wallace MP: Bioabsorbable polymeric material coils for embolization of intracranial aneurysms: a preliminary experimental study. J Neurosurg 94:454–463, 2001
Ng P, , Khangure MS, , Phatouros CC, , Bynevelt M, , ApSimon H, & McAuliffe W: Endovascular treatment of intracranial aneurysms with Guglielmi detachable coils. Analysis of midterm angiographic and clinical outcomes. Stroke 33:210–217, 2002 Ng P, Khangure MS, Phatouros CC, Bynevelt M, ApSimon H, McAuliffe W: Endovascular treatment of intracranial aneurysms with Guglielmi detachable coils. Analysis of midterm angiographic and clinical outcomes. Stroke 33:210–217, 2002
Niemann D, , Aviv R, , Cowsill C, , Sneade M, & Molyneux AJ: Anatomically conformable, three-dimensional, detachable platinum microcoil system for the treatment of intracranial aneurysms. AJNR 25:813–818, 2004 Niemann D, Aviv R, Cowsill C, Sneade M, Molyneux AJ: Anatomically conformable, three-dimensional, detachable platinum microcoil system for the treatment of intracranial aneurysms. AJNR 25:813–818, 2004
Raymond J, , Guilbert F, , Weill A, , Georganos SA, , Juravsky L, & Lambert A, et al: Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34:1398–1403, 2003 Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, et al: Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34:1398–1403, 2003
Roy D, , Milot G, & Raymond J: Endovascular treatment of unruptured aneurysms. Stroke 32:1998–2004, 2001 Roy D, Milot G, Raymond J: Endovascular treatment of unruptured aneurysms. Stroke 32:1998–2004, 2001
Satoh K, , Matsubara S, , Hodoh H, & Nagahiro S: Intracranial aneurysm embolization using interlocking detachable coils: correlation between volume embolization and coil compaction. Intervent Neuroradiol 3 (Suppl 2):125–128, 1997 Satoh K, Matsubara S, Hodoh H, Nagahiro S: Intracranial aneurysm embolization using interlocking detachable coils: correlation between volume embolization and coil compaction. Intervent Neuroradiol 3 (Suppl 2):125–128, 1997
Sluzewski M, , van Rooij WJ, , Rinkel GJ, & Wijnalda D: Endovascular treatment of ruptured intracranial aneurysms with detachable coils: long-term clinical and serial angiographic results. Radiology 227:720–724, 2003 Sluzewski M, van Rooij WJ, Rinkel GJ, Wijnalda D: Endovascular treatment of ruptured intracranial aneurysms with detachable coils: long-term clinical and serial angiographic results. Radiology 227:720–724, 2003
Sluzewski M, , van Rooij WJ, , Slob MJ, , Bescos JO, , Slump CH, & Wijnalda D: Relation between aneurysm volume, packing, and compaction in 145 cerebral aneurysms treated with coils. Radiology 231:653–658, 2004 Sluzewski M, van Rooij WJ, Slob MJ, Bescos JO, Slump CH, Wijnalda D: Relation between aneurysm volume, packing, and compaction in 145 cerebral aneurysms treated with coils. Radiology 231:653–658, 2004
Steinman DA, , Milner JS, , Norley CJ, , Lownie SP, & Holdsworth DW: Image-based computational simulation of flow dynamics in a giant intracranial aneurysm. AJNR 24:559–566, 2003 Steinman DA, Milner JS, Norley CJ, Lownie SP, Holdsworth DW: Image-based computational simulation of flow dynamics in a giant intracranial aneurysm. AJNR 24:559–566, 2003
Tamatani S, , Ito Y, , Abe H, , Koike T, , Takeuchi S, & Tanaka R: Evaluation of the stability of aneurysms after embolization using detachable coils: correlation between stability of aneurysms and embolized volume of aneurysms. AJNR 23:762–767, 2002 Tamatani S, Ito Y, Abe H, Koike T, Takeuchi S, Tanaka R: Evaluation of the stability of aneurysms after embolization using detachable coils: correlation between stability of aneurysms and embolized volume of aneurysms. AJNR 23:762–767, 2002
Taylor CL, , Yuan Z, , Selman WR, , Ratcheson RA, & Rimm AA: Cerebral arterial aneurysm formation and rupture in 20,767 elderly patients: hypertension and other risk factors. J Neurosurg 83:812–819, 1995 Taylor CL, Yuan Z, Selman WR, Ratcheson RA, Rimm AA: Cerebral arterial aneurysm formation and rupture in 20,767 elderly patients: hypertension and other risk factors. J Neurosurg 83:812–819, 1995
Thornton J, , Debrun GM, , Aletich VA, , Bashir Q, , Charbel FT, & Ausman J: Follow-up angiography of intracranial aneurysms treated with endovascular placement of Guglielmi detachable coils. Neurosurgery 50:239–250, 2002 Thornton J, Debrun GM, Aletich VA, Bashir Q, Charbel FT, Ausman J: Follow-up angiography of intracranial aneurysms treated with endovascular placement of Guglielmi detachable coils. Neurosurgery 50:239–250, 2002
Tummala RP, , Chu RM, , Madison MT, , Myers M, , Tubman D, & Nussbaum ES: Outcomes after aneurysm rupture during endovascular coil embolization. Neurosurgery 49:1059–1067, 2001 Tummala RP, Chu RM, Madison MT, Myers M, Tubman D, Nussbaum ES: Outcomes after aneurysm rupture during endovascular coil embolization. Neurosurgery 49:1059–1067, 2001
Uchiyama N, , Kida S, , Nomura M, , Hasegawa M, , Yamashima T, & Yamashita J, et al: Significance of volume embolization ratio as a predictor of recanalization on endovascular treatment of cerebral aneurysms treated with Guglielmi detachable coils. Intervent Neuroradiol 6:59–63, 2000 Uchiyama N, Kida S, Nomura M, Hasegawa M, Yamashima T, Yamashita J, et al: Significance of volume embolization ratio as a predictor of recanalization on endovascular treatment of cerebral aneurysms treated with Guglielmi detachable coils. Intervent Neuroradiol 6:59–63, 2000
Viñuela F, , Duckwiler G, & Mawad M: Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86:475–482, 1997 Viñuela F, Duckwiler G, Mawad M: Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86:475–482, 1997
All Time | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 650 | 110 | 16 |
Full Text Views | 143 | 6 | 1 |
PDF Downloads | 77 | 4 | 1 |
EPUB Downloads | 0 | 0 | 0 |