Intracranial aneurysms treated with the Guglielmi detachable coil: midterm clinical results in a consecutive series of 100 patients

Restricted access

✓ A prospective study was designed to evaluate clinical outcome in a series of 100 consecutively treated patients who underwent endovascular embolization of 104 intracranial aneurysms using Guglielmi detachable coils (GDCs). Midterm clinical outcome (2–6 years, average 3.5 years) was obtained for 94 patients and was classified according to a modified Glasgow Outcome Scale.

Of nine patients treated in the acute phase of severe subarachnoid hemorrhage (Grade IV or V), seven died from the initial hemorrhage, one had a poor outcome, and one had a fair midterm outcome, with no post-GDC embolization hemorrhages.

Twenty patients underwent subsequent surgical or endovascular procedures that did not include the use of GDCs. These included aneurysm clipping in nine patients and parent vessel sacrifice in 11 patients. None of these 20 patients experienced post-GDC embolization hemorrhage. The postoperative midterm clinical outcomes of these 20 patients did not significantly differ from the outcomes of patients who underwent GDC embolization as their definitive treatment.

Six patients died of unrelated causes prior to reaching the 2-year survival point, with no post-GDC embolization hemorrhage. The midterm outcomes of the remaining 61 patients who underwent GDC embolization as their definitive treatment were classified as excellent (46 patients [75%]), good (seven patients [11%]), fair (three patients [5%]), poor (one patient [2%]), or dead (four patients [7%]). All four patients died from giant lesions. At midterm follow up, the surviving 57 patients' neurological statuses were unchanged or improved in 54 cases and worsened in three cases. The midterm post-GDC embolization hemorrhage rate was 0% for small aneurysms, 4% (one case) for large aneurysms, and 33% (five cases) for giant lesions.

The GDC procedure is a safe, effective, and reliable means of preventing aneurysm hemorrhage in patients with small and large intracranial aneurysms. Results, however, are less satisfactory in cases involving giant lesions. Further follow-up review is necessary to establish durability in the longer term. Patients with Grade IV or V subarachnoid hemorrhage in this series generally had poor outcomes even if the GDC procedure was successful in occluding the aneurysm.

Article Information

Address reprint requests to: Tim W. Malisch, M.D., Section of Interventional Neuroradiology, Northwestern Memorial Hospital, 710 North Fairbanks, Olson Pavilion, Chicago, Illinois 60611.

© AANS, except where prohibited by US copyright law.

Headings

References

  • 1.

    Drake CGAllcock JM: Postoperative angiography and the “slipped” clip. J Neurosurg 39:6836891973Drake CG Allcock JM: Postoperative angiography and the “slipped” clip. J Neurosurg 39:683–689 1973

    • Search Google Scholar
    • Export Citation
  • 2.

    Drake CGFriedman AHPeerless SJ: Failed aneurysm surgery. Reoperation in 115 cases. J Neurosurg 61:8488561984Drake CG Friedman AH Peerless SJ: Failed aneurysm surgery. Reoperation in 115 cases. J Neurosurg 61:848–856 1984

    • Search Google Scholar
    • Export Citation
  • 3.

    Drake CGVanderlinden RG: The late consequences of incomplete surgical treatment of cerebral aneurysms. J Neurosurg 27:2262381967Drake CG Vanderlinden RG: The late consequences of incomplete surgical treatment of cerebral aneurysms. J Neurosurg 27:226–238 1967

    • Search Google Scholar
    • Export Citation
  • 4.

    Ebina KSuzuki MAndoh Aet al: Recurrence of cerebral aneurysm after initial neck clipping. Neurosurgery 11:7647681982Ebina K Suzuki M Andoh A et al: Recurrence of cerebral aneurysm after initial neck clipping. Neurosurgery 11:764–768 1982

    • Search Google Scholar
    • Export Citation
  • 5.

    Fernandez Zubillaga AGuglielmi GViñuela Fet al: Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysms, neck size and treatment results. AJNR 15:8158201994Fernandez Zubillaga A Guglielmi G Viñuela F et al: Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysms neck size and treatment results. AJNR 15:815–820 1994

    • Search Google Scholar
    • Export Citation
  • 6.

    Feuerberg ILindquist CLindqvist Met al: Natural history of postoperative aneurysm rests. J Neurosurg 66:30341987Feuerberg I Lindquist C Lindqvist M et al: Natural history of postoperative aneurysm rests. J Neurosurg 66:30–34 1987

    • Search Google Scholar
    • Export Citation
  • 7.

    Giannotta SLLitofsky NS: Reoperative management of intracranial aneurysms. J Neurosurg 83:3873931995Giannotta SL Litofsky NS: Reoperative management of intracranial aneurysms. J Neurosurg 83:387–393 1995

    • Search Google Scholar
    • Export Citation
  • 8.

    Gobin YPViñuela FGurian JHet al: Treatment of large and giant fusiform intracranial aneurysms with Guglielmi detachable coils. J Neurosurg 84:55621996Gobin YP Viñuela F Gurian JH et al: Treatment of large and giant fusiform intracranial aneurysms with Guglielmi detachable coils. J Neurosurg 84:55–62 1996

    • Search Google Scholar
    • Export Citation
  • 9.

    Graves VBStrother CMDuff TAet al: Early treatment of ruptured aneurysms with Guglielmi detachable coils: effect on subsequent bleeding. Neurosurgery 37:6406481995Graves VB Strother CM Duff TA et al: Early treatment of ruptured aneurysms with Guglielmi detachable coils: effect on subsequent bleeding. Neurosurgery 37:640–648 1995

    • Search Google Scholar
    • Export Citation
  • 10.

    Guglielmi GViñuela FDion Jet al: Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. J Neurosurg 75:8141991Guglielmi 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
  • 11.

    Guglielmi GViñuela FDuckwiler G: Coil-induced thrombosis of intracranial aneurysms in Maciunas R (ed): Endovascular Neurological Intervention. Park Ridge, Ill: American Association of Neurological Surgeons1995 pp 179188Guglielmi G Viñuela F Duckwiler G: Coil-induced thrombosis of intracranial aneurysms in Maciunas R (ed): Endovascular Neurological Intervention. Park Ridge Ill: American Association of Neurological Surgeons 1995 pp 179–188

    • Search Google Scholar
    • Export Citation
  • 12.

    Guglielmi GViñuela FDuckwiler Get al: Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg 77:5155241992Guglielmi 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
  • 13.

    Guglielmi GViñuela FSepetka Iet al: Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: Electrochemical basis, technique and experimental results. J Neurosurg 75:171991Guglielmi G Viñuela F Sepetka I et al: Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: Electrochemical basis technique and experimental results. J Neurosurg 75:1–7 1991

    • Search Google Scholar
    • Export Citation
  • 14.

    Higashida RTHalbach VVDowd CFet al: Intracranial aneurysms. Evolution and future role of endovascular techniques. Neurosurg Clin North Am 5:4134251994Higashida RT Halbach VV Dowd CF et al: Intracranial aneurysms. Evolution and future role of endovascular techniques. Neurosurg Clin North Am 5:413–425 1994

    • Search Google Scholar
    • Export Citation
  • 15.

    Hunt WEHess RM: Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14201968Hunt WE Hess RM: Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–20 1968

    • Search Google Scholar
    • Export Citation
  • 16.

    Jennett BBond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:4804841975Jennett B Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480–484 1975

    • Search Google Scholar
    • Export Citation
  • 17.

    Kassell NFTorner JCHaley EC Jret al: The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results. J Neurosurg 73:18361990Kassell NF Torner JC Haley EC Jr et al: The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results. J Neurosurg 73:18–36 1990

    • Search Google Scholar
    • Export Citation
  • 18.

    Kassell NFTorner JCJane JAet al: The International Cooperative Study on the Timing of Aneurysm Surgery. Part 2: Surgical results. J Neurosurg 73:37471990Kassell 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
  • 19.

    Lin TFox AJDrake CG: Regrowth of aneurysm sacs from residual neck following aneurysm clipping. J Neurosurg 70:5565601989Lin T Fox AJ Drake CG: Regrowth of aneurysm sacs from residual neck following aneurysm clipping. J Neurosurg 70:556–560 1989

    • Search Google Scholar
    • Export Citation
  • 20.

    Martin DRodesch GAlvarez Het al: Preliminary results of embolisation of nonsurgical intracranial aneurysms with GD coils: the 1st year of their use. Neuroradiology 38 (Suppl 1) S142S1501996Martin D Rodesch G Alvarez H et al: Preliminary results of embolisation of nonsurgical intracranial aneurysms with GD coils: the 1st year of their use. Neuroradiology 38 (Suppl 1) S142–S150 1996

    • Search Google Scholar
    • Export Citation
  • 21.

    McDougall CGHalbach VVDowd CFet al: Endovascular treatment of basilar tip aneurysms using electrolytically detachable coils. J Neurosurg 84:3933991996McDougall CG Halbach VV Dowd CF et al: Endovascular treatment of basilar tip aneurysms using electrolytically detachable coils. J Neurosurg 84:393–399 1996

    • Search Google Scholar
    • Export Citation
  • 22.

    Miyaoka MSato KIshii S: A clinical study of the relationship of timing to outcome of surgery for ruptured cerebral aneurysms. A retrospective analysis of 1622 cases. J Neurosurg 79:3733781993Miyaoka M Sato K Ishii S: A clinical study of the relationship of timing to outcome of surgery for ruptured cerebral aneurysms. A retrospective analysis of 1622 cases. J Neurosurg 79:373–378 1993

    • Search Google Scholar
    • Export Citation
  • 23.

    Nichols DA: Endovascular treatment of the acutely ruptured intracranial aneurysm. J Neurosurg 79:121993Nichols DA: Endovascular treatment of the acutely ruptured intracranial aneurysm. J Neurosurg 79:1–2 1993

    • Search Google Scholar
    • Export Citation
  • 24.

    Nichols DAMeyer FBPiepgras DGet al: Endovascular treatment of intracranial aneurysms. Mayo Clin Proc 69:2722851994Nichols DA Meyer FB Piepgras DG et al: Endovascular treatment of intracranial aneurysms. Mayo Clin Proc 69:272–285 1994

    • Search Google Scholar
    • Export Citation
  • 25.

    Pierot LBoulin ACastaings Let al: Selective occlusion of basilar artery aneurysms using controlled detachable coils: report of 35 cases. Neurosurgery 38:9489541996Pierot L Boulin A Castaings L et al: Selective occlusion of basilar artery aneurysms using controlled detachable coils: report of 35 cases. Neurosurgery 38:948–954 1996

    • Search Google Scholar
    • Export Citation
  • 26.

    Scotti GRighi CSimionato Fet al: Trattamento endovascolare degli aneurismi intracranici con spirali staccabili (GDC). Riv Neuroradiol 7:7237331994Scotti G Righi C Simionato F et al: Trattamento endovascolare degli aneurismi intracranici con spirali staccabili (GDC). Riv Neuroradiol 7:723–733 1994

    • Search Google Scholar
    • Export Citation
  • 27.

    Weir BKADrake CG: Rapid growth of residual aneurysm neck during pregnancy. Case report. J Neurosurg 75:7807821991Weir BKA Drake CG: Rapid growth of residual aneurysm neck during pregnancy. Case report. J Neurosurg 75:780–782 1991

    • Search Google Scholar
    • Export Citation

TrendMD

Cited By

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 132 132 25
Full Text Views 169 169 0
PDF Downloads 89 89 0
EPUB Downloads 0 0 0

PubMed

Google Scholar