Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils

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  • 1 Department of Neurological Sciences (Therapeutic Neuroangiography), University of Rome, Rome, Italy; Departments of Radiology, University of California, Los Angeles, California; New York University, New York, New York; University of Wisconsin, Madison, Wisconsin; University of California, San Francisco, California; Mayo Clinic, Rochester, Minnesota, University of Virginia, Charlottesville, Virginia; and Baptist Memorial Hospital, Memphis, Tennessee; F.L.E.N.I., Buenos Aires, Argentina; Department of Neurosurgery, State University of New York, Buffalo, New York; and Target Therapeutics, San Jose, California
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✓ In a multicenter study, 120 patients with intracranial aneurysms presenting a high surgical risk were treated using electrolytically detachable coils and electrothrombosis via an endovascular approach. The results of treatment in patients with posterior fossa aneurysms (42 patients with 43 aneurysms) are presented. The most frequent clinical presentation was subarachnoid hemorrhage (24 cases). The clinical follow-up periods ranged from 1 week to 18 months. Complete aneurysm occlusion was obtained in 13 of 16 aneurysms with a small neck and in four of 26 wide-necked aneurysms. A 70% to 98% thrombosis of the aneurysm was achieved in 22 of 26 aneurysms with a wide neck and in three of 16 small-necked aneurysms. One aneurysm could not be treated due to a technical complication. Two cases required postprocedural surgical clipping of a residual aneurysm.

One patient (originally in Hunt and Hess Grade V) experienced procedural rupture of the aneurysm requiring an emergency parent artery occlusion. He eventually died 5 days later. Another patient (originally in Grade IV) had coil migration and posterior cerebral artery territory ischemia. A third patient developed a permanent neurological deficit (hemianopsia) after complete occlusion of a wide-necked basilar bifurcation aneurysm. One patient, harboring an inoperable giant basilar bifurcation aneurysm, died from aneurysm bleeding 18 months after partial occlusion.

Overall morbidity and mortality rates related to treatment were 4.8% (two cases) and 2.4% (one case), respectively (2.6% and 0% if considering only patients in Hunt and Hess Grades I, II, and III).

It is suggested that this technique is a viable alternative in the management of patients with posterior fossa aneurysms associated with high surgical risk. Longer angiographic and clinical follow-up study is necessary to determine the long-term efficacy of this recently developed endovascular occlusion technique. Close postoperative angiographic and clinical monitoring of patients with wide-necked subtotally occluded aneurysms is mandatory to check for potential aneurysmal recanalization, regrowth, and rupture.

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Contributor Notes

Address reprint requests to: Guido Guglielmi, M.D., Dipartimento di Scienze Neurologiche, Neuroangiografia Terapeutica, Universita' di Roma, Viale dell'Universita' 30/a, 00185 Roma, Italy.
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