Endovascular treatment of multiple intracranial aneurysms by using Guglielmi detachable coils

Restricted access

Object. The purpose of this paper is to present the authors' experience with Guglielmi detachable coil (GDC) embolization of multiple intracranial aneurysms and to evaluate the results of this therapy in single-stage procedures.

Methods. Clinical and angiographic evaluations were performed in 38 consecutive patients with multiple intracranial aneurysms treated by GDC embolization between March 1990 and October 1997. Twenty-nine patients presented with subarachnoid hemorrhage (SAH), four with mass effect, and five were asymptomatic. These 38 patients harbored 101 aneurysms, 79 of which were treated with GDCs, 14 by surgical clipping, and eight were left untreated. Of the GDC-treated lesions, a complete endovascular occlusion was achieved in 55 aneurysms (70%), and 24 (30%) presented neck remnants. Twenty-five patients (66%) underwent GDC embolization of more than one aneurysm in the first session. Eighteen (86%) of 21 patients with acute SAH underwent treatment for all aneurysms within 3 days after admission (15 of 21 in one session). Follow-up angiographic studies in 30 patients demonstrated an unchanged or improved result in 94% of the aneurysms (59 lesions) and coil compaction in 6% (four lesions). The overall clinical outcome was excellent in 34 patients (89%), good in one (3%), fair in one (3%), and death in two (5%).

Conclusions. Endovascular treatment of multiple intracranial aneurysms, regardless of their location, with GDCs was performed safely in one session, even during the acute phase of SAH. Treatment of all aneurysms in one session protected the patient from rebleeding and eliminated the risk of mistakenly treating only the unruptured aneurysms.

Article Information

Contributor Notes

Address reprint requests to: Sten Solander, M.D., Department of Diagnostic Radiology, University Hospital, S-751, 85 Uppsala, Sweden. email: Sten.Solander@radiol.uu.se.
Headings
References
  • 1.

    Asari SOhmoto T: Natural history and risk factors of unruptured cerebral aneurysms. Clin Surg Neurol 95:2052141993Asari S Ohmoto T: Natural history and risk factors of unruptured cerebral aneurysms. Clin Surg Neurol 95:205–214 1993

    • Search Google Scholar
    • Export Citation
  • 2.

    Cervoni LDelfini RSantoro Aet al: Multiple intracranial aneurysms: surgical treatment and outcome. Acta Neurochir 124:66701993Cervoni L Delfini R Santoro A et al: Multiple intracranial aneurysms: surgical treatment and outcome. Acta Neurochir 124:66–70 1993

    • Search Google Scholar
    • Export Citation
  • 3.

    Civit TAuque JMarchal JCet al: Aneurysm clipping after endovascular treatment with coils: a report of eight patients. Neurosurgery 38:9559611996Civit T Auque J Marchal JC et al: Aneurysm clipping after endovascular treatment with coils: a report of eight patients. Neurosurgery 38:955–961 1996

    • Search Google Scholar
    • Export Citation
  • 4.

    de Oliveira ETedeschi HSiqueira MGet al: Anatomical and technical aspects of the contralateral approach for multiple aneurysms. Acta Neurochir 138:1111996de Oliveira E Tedeschi H Siqueira MG et al: Anatomical and technical aspects of the contralateral approach for multiple aneurysms. Acta Neurochir 138:1–11 1996

    • Search Google Scholar
    • Export Citation
  • 5.

    Edner G: One-session operation via bilateral craniotomies for multiple aneurysms after subarachnoid haemorrhage. Br J Neurosurg 5:55601991Edner G: One-session operation via bilateral craniotomies for multiple aneurysms after subarachnoid haemorrhage. Br J Neurosurg 5:55–60 1991

    • Search Google Scholar
    • Export Citation
  • 6.

    Fernandez Zubillaga AGuglielmi GViñuela Fet al: Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm 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 aneurysm neck size and treatment results. AJNR 15:815–820 1994

    • Search Google Scholar
    • Export Citation
  • 7.

    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
  • 8.

    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
  • 9.

    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
  • 10.

    Gurian JHMartin NAKing WAet al: Neurosurgical management of cerebral aneurysms following unsuccessful or incomplete endovascular embolization. J Neurosurg 83:8438531995Gurian JH Martin NA King WA et al: Neurosurgical management of cerebral aneurysms following unsuccessful or incomplete endovascular embolization. J Neurosurg 83:843–853 1995

    • Search Google Scholar
    • Export Citation
  • 11.

    Havranek EPNademanee KGrayburn PAet al: Endothelium-dependent vasorelaxation is impaired in cocaine arteriopathy. J Am Coll Cardiol 28:116811741996Havranek EP Nademanee K Grayburn PA et al: Endothelium-dependent vasorelaxation is impaired in cocaine arteriopathy. J Am Coll Cardiol 28:1168–1174 1996

    • Search Google Scholar
    • Export Citation
  • 12.

    Heiskanen O: Risk of bleeding from unruptured aneurysms in cases with multiple intracranial aneurysms. J Neurosurg 55:5245261981Heiskanen O: Risk of bleeding from unruptured aneurysms in cases with multiple intracranial aneurysms. J Neurosurg 55:524–526 1981

    • Search Google Scholar
    • Export Citation
  • 13.

    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
  • 14.

    Inagawa T: Multiple intracranial aneurysms in elderly patients. Acta Neurochir 106:1191261990Inagawa T: Multiple intracranial aneurysms in elderly patients. Acta Neurochir 106:119–126 1990

    • Search Google Scholar
    • Export Citation
  • 15.

    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
  • 16.

    Juvela SPorras MHeiskanen O: Natural history of unruptured intracranial aneurysms: a long-term follow-up study. J Neurosurg 79:1741821993Juvela S Porras M Heiskanen O: Natural history of unruptured intracranial aneurysms: a long-term follow-up study. J Neurosurg 79:174–182 1993

    • Search Google Scholar
    • Export Citation
  • 17.

    Kaku YYonekawa YTsukahara Tet al: Superselective intra-arterial infusion of papaverine for the treatment of cerebral vasospasm after subarachnoid hemorrhage. J Neurosurg 77:8428471992Kaku Y Yonekawa Y Tsukahara T et al: Superselective intra-arterial infusion of papaverine for the treatment of cerebral vasospasm after subarachnoid hemorrhage. J Neurosurg 77:842–847 1992

    • Search Google Scholar
    • Export Citation
  • 18.

    Kassell NFHelm GSimmons Net al: Treatment of cerebral vasospasm with intra-arterial papaverine. J Neurosurg 77:8488521992Kassell NF Helm G Simmons N et al: Treatment of cerebral vasospasm with intra-arterial papaverine. J Neurosurg 77:848–852 1992

    • Search Google Scholar
    • Export Citation
  • 19.

    Kassell NFPeerless SJDurward QJet al: Treatment of ischemic deficits from vasospasm with intravascular volume expansion and induced arterial hypertension. Neurosurgery 11:3373431982Kassell NF Peerless SJ Durward QJ et al: Treatment of ischemic deficits from vasospasm with intravascular volume expansion and induced arterial hypertension. Neurosurgery 11:337–343 1982

    • Search Google Scholar
    • Export Citation
  • 20.

    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
  • 21.

    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
  • 22.

    King JT JrBerlin JAFlamm ES: Morbidity and mortality from elective surgery for asymptomatic, unruptured, intracranial aneurysms: a meta-analysis. J Neurosurg 81:8378421994King JT Jr Berlin JA Flamm ES: Morbidity and mortality from elective surgery for asymptomatic unruptured intracranial aneurysms: a meta-analysis. J Neurosurg 81:837–842 1994

    • Search Google Scholar
    • Export Citation
  • 23.

    Malisch TWGuglielmi GViñuela Fet al: Intracranial aneurysms treated with the Guglielmi detachable coil: midterm clinical results in a consecutive series of 100 patients. J Neurosurg 87:1761831997Malisch TW Guglielmi G Viñuela F et al: Intracranial aneurysms treated with the Guglielmi detachable coil: midterm clinical results in a consecutive series of 100 patients. J Neurosurg 87:176–183 1997

    • Search Google Scholar
    • Export Citation
  • 24.

    Massoud TFGuglielmi GViñuela Fet al: Endovascular treatment of multiple aneurysms involving the posterior intracranial circulation. AJNR 17:5495541996Massoud TF Guglielmi G Viñuela F et al: Endovascular treatment of multiple aneurysms involving the posterior intracranial circulation. AJNR 17:549–554 1996

    • Search Google Scholar
    • Export Citation
  • 25.

    Mathis JMJensen MEDion JE: Technical considerations on intra-arterial papaverine hydrochloride for cerebral vasospasm. Neuroradiology 39:90981997Mathis JM Jensen ME Dion JE: Technical considerations on intra-arterial papaverine hydrochloride for cerebral vasospasm. Neuroradiology 39:90–98 1997

    • Search Google Scholar
    • Export Citation
  • 26.

    Mizoi KSuzuki JYoshimoto T: Surgical treatment of multiple aneurysms. Review of experience with 372 cases. Acta Neurochir 96:8141989Mizoi K Suzuki J Yoshimoto T: Surgical treatment of multiple aneurysms. Review of experience with 372 cases. Acta Neurochir 96:8–14 1989

    • Search Google Scholar
    • Export Citation
  • 27.

    Moret JCognard CWeill Aet al: La technique de reconstruction dans le traitement des anévrismes intracrâniens à collet large. Résultats angiographiques et cliniques à long terme. A propos de 56 cas. J Neuroradiol 24:30441997Moret J Cognard C Weill A et al: La technique de reconstruction dans le traitement des anévrismes intracrâniens à collet large. Résultats angiographiques et cliniques à long terme. A propos de 56 cas. J Neuroradiol 24:30–44 1997

    • Search Google Scholar
    • Export Citation
  • 28.

    Nehls DGFlom RACarter LPet al: Multiple intracranial aneurysms: determining the site of rupture. J Neurosurg 63:3423481985Nehls DG Flom RA Carter LP et al: Multiple intracranial aneurysms: determining the site of rupture. J Neurosurg 63:342–348 1985

    • Search Google Scholar
    • Export Citation
  • 29.

    Nemoto MYasui NSuzuki Aet al: [Problems of surgical treatment for multiple intracranial aneurysms.] Neurol Med Chir 31:8928981991 (Jpn)Nemoto M Yasui N Suzuki A et al: [Problems of surgical treatment for multiple intracranial aneurysms.] Neurol Med Chir 31:892–898 1991 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 30.

    Nichols DABrown RD JrThielen KRet al: Endovascular treatment of ruptured posterior circulation aneurysms using electrolytically detachable coils. J Neurosurg 87:3743801997Nichols DA Brown RD Jr Thielen KR et al: Endovascular treatment of ruptured posterior circulation aneurysms using electrolytically detachable coils. J Neurosurg 87:374–380 1997

    • Search Google Scholar
    • Export Citation
  • 31.

    Orz YOsawa YTanaka Yet al: Surgical outcome for multiple intracranial aneurysms. Acta Neurochir 138:4114171996Orz Y Osawa Y Tanaka Y et al: Surgical outcome for multiple intracranial aneurysms. Acta Neurochir 138:411–417 1996

    • Search Google Scholar
    • Export Citation
  • 32.

    Oshiro EMRini DATamargo RJ: Contralateral approaches to bilateral cerebral aneurysms: a microsurgical anatomical study. J Neurosurg 87:1631691997Oshiro EM Rini DA Tamargo RJ: Contralateral approaches to bilateral cerebral aneurysms: a microsurgical anatomical study. J Neurosurg 87:163–169 1997

    • Search Google Scholar
    • Export Citation
  • 33.

    Pierot LBoulin ACastaings Let al: The endovascular approach in the management of patients with multiple intracranial aneurysms. Neuroradiology 39:3613661997Pierot L Boulin A Castaings L et al: The endovascular approach in the management of patients with multiple intracranial aneurysms. Neuroradiology 39:361–366 1997

    • Search Google Scholar
    • Export Citation
  • 34.

    Raymond JRoy DBojanowski Met al: Endovascular treatment of acutely ruptured and unruptured aneurysms of the basilar bifurcation. J Neurosurg 86:2112191997Raymond J Roy D Bojanowski M et al: Endovascular treatment of acutely ruptured and unruptured aneurysms of the basilar bifurcation. J Neurosurg 86:211–219 1997

    • Search Google Scholar
    • Export Citation
  • 35.

    Rinne JHernesniemi JNiskanen Met al: Management out-come for multiple intracranial aneurysms. Neurosurgery 36:31381995Rinne J Hernesniemi J Niskanen M et al: Management out-come for multiple intracranial aneurysms. Neurosurgery 36:31–38 1995

    • Search Google Scholar
    • Export Citation
  • 36.

    Rinne JHernesniemi JPuranen Met al: Multiple intracranial aneurysms in a defined population: prospective angiographic and clinical study. Neurosurgery 35:8038081994Rinne J Hernesniemi J Puranen M et al: Multiple intracranial aneurysms in a defined population: prospective angiographic and clinical study. Neurosurgery 35:803–808 1994

    • Search Google Scholar
    • Export Citation
  • 37.

    Swift DMSolomon RA: Unruptured aneurysms and postoperative volume expansion. J Neurosurg 77:9089101992Swift DM Solomon RA: Unruptured aneurysms and postoperative volume expansion. J Neurosurg 77:908–910 1992

    • Search Google Scholar
    • Export Citation
  • 38.

    Vajda J: Multiple intracranial aneurysms: a high risk condition. Acta Neurochir 118:59751992Vajda J: Multiple intracranial aneurysms: a high risk condition. Acta Neurochir 118:59–75 1992

    • Search Google Scholar
    • Export Citation
  • 39.

    Vajda J: Unruptured aneurysms: should all be obliterated at once? J Neurosurg 79:3081993 (Letter)Vajda J: Unruptured aneurysms: should all be obliterated at once? J Neurosurg 79:308 1993 (Letter)

    • Search Google Scholar
    • Export Citation
  • 40.

    Vajda JJuhász JOrosz Eet al: Surgical treatment of multiple intracranial aneurysms. Acta Neurochir 82:14231986Vajda J Juhász J Orosz E et al: Surgical treatment of multiple intracranial aneurysms. Acta Neurochir 82:14–23 1986

    • Search Google Scholar
    • Export Citation
  • 41.

    Viñuela FDuckwiler GMawad M: Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86:4754821997Viñuela 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

    • Search Google Scholar
    • Export Citation
  • 42.

    Winn HRAlmaani WSBerga SLet al: The long-term outcome in patients with multiple aneurysms. Incidence of late hemorrhage and implications for treatment of incidental aneurysms. J Neurosurg 59:6426511983Winn HR Almaani WS Berga SL et al: The long-term outcome in patients with multiple aneurysms. Incidence of late hemorrhage and implications for treatment of incidental aneurysms. J Neurosurg 59:642–651 1983

    • Search Google Scholar
    • Export Citation
  • 43.

    Yasui NMagarisawa SSuzuki Aet al: Subarachniod hemorrhage caused by previously diagnosed, previously unruptured intracranial aneurysms: a retrospective analysis of 25 cases. Neurosurgery 39:109611011996Yasui N Magarisawa S Suzuki A et al: Subarachniod hemorrhage caused by previously diagnosed previously unruptured intracranial aneurysms: a retrospective analysis of 25 cases. Neurosurgery 39:1096–1101 1996

    • Search Google Scholar
    • Export Citation
  • 44.

    Yasui NSuzuki ANishimura Het al: Long-term follow-up study of unruptured intracranial aneurysms. Neurosurgery 40:115511601997Yasui N Suzuki A Nishimura H et al: Long-term follow-up study of unruptured intracranial aneurysms. Neurosurgery 40:1155–1160 1997

    • Search Google Scholar
    • Export Citation
  • 45.

    Zubkov YNNikiforov BMShustin VA: Balloon catheter technique for dilatation of constricted cerebral arteries after aneurysmal SAH. Acta Neurochir 70:65791984Zubkov YN Nikiforov BM Shustin VA: Balloon catheter technique for dilatation of constricted cerebral arteries after aneurysmal SAH. Acta Neurochir 70:65–79 1984

    • Search Google Scholar
    • Export Citation
TrendMD
Cited By
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 126 124 4
Full Text Views 188 103 0
PDF Downloads 87 53 0
EPUB Downloads 0 0 0
PubMed
Google Scholar