Endovascular treatment of basilar tip aneurysms using electrolytically detachable coils

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✓ Preliminary experience using electrolytically detachable coils to treat basilar tip aneurysms in 33 patients is described. The most frequent presentation was subarachnoid hemorrhage (SAH) in 23 patients. All patients were referred after neurosurgical assessment and exclusion as candidates for surgical clipping of their aneurysms. At the time of initial treatment complete aneurysm occlusion was achieved in seven (21.2%) of 33 patients. In 17 of the patients (51.5%), greater than 90% but less than 100% aneurysm occlusion was achieved. Angiographic follow up (mean 11.7 months) was available in 19 patients. At follow-up angiography four (21%) of 19 aneurysms were 100% occluded and 12 (63.2%) of 19 were more than 90% but less than 100% occluded.

The mean clinical follow-up time in treated patients surviving beyond the initial treatment period is 15 months. One patient suffered major permanent morbidity from thrombosis of the basilar tip region a few hours after coil placement. One patient treated following SAH experienced further hemorrhage 6 months later. No other patient suffered direct or indirect permanent morbidity as a consequence of this method of treatment.

The authors believe that this technique is a reasonable alternative for patients who are not candidates for conventional surgical treatment or in whom such treatment has failed. This study's follow-up period is brief and greater experience with long-term follow-up study is mandatory.

Article Information

Address reprint requests to: Cameron G. McDougall, M.D., Barrow Neurological Institute, 2910 North Third Avenue, Phoenix, Arizona 85013.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 14. Frontal and lateral angiographic views showing basilar tip aneurysm prior to treatment (A and B) and 4 months after treatment (C and D). Frontal view, at 16-month follow up (E).

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    Case 21. Frontal angiographic view (A) showing basilar tip aneurysm in 1986 at the time of initial hemorrhage. Axial computerized tomography scan (B) in the same patient in 1993 following presentation with mass effect. Frontal and lateral angiograms before (C and D) and after (E and F) retreatment.

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    Case 10. Frontal angiographic view pre- (A) and frontal and lateral views posttreatment (B and C). Frontal and lateral views 1 year after initial treatment but prior to retreatment (D and E) and at 7 months following retreatment (F and G).

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    Case 18. Frontal angiographic views showing basilar tip aneurysm prior to attempted treatment (A) and with coil positioned within the aneurysm but not detached (B).

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    Case 24. Frontal and lateral angiographic views showing basilar tip aneurysm before (A and B) and after treatment (C and D).

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