Natural history of the neck remnant of a cerebral aneurysm treated with the Guglielmi detachable coil system

Restricted access

Object. The long-term durability of Guglielmi detachable coil (GDC) embolization of cerebral aneurysms is still unknown. The purpose of this study was to evaluate the anatomical evolution of neck remnants in aneurysms treated with GDCs.

Methods. Of 455 aneurysms treated with GDCs from 1990 to 1998 at the University of California at Los Angeles Medical Center, 178 aneurysms (39%) had residual necks postembolization. Long-term follow-up angiograms were obtained in 73 of these aneurysms in 71 patients. The mean duration of angiographic follow up was 17.3 months. Twenty-four of the aneurysms were small with small necks, 24 were small with wide necks, 15 were large, and 10 were giant aneurysms.

In small aneurysms with small necks, postembolization angiography revealed 12 aneurysms (50%) with progressive thrombosis, eight (33%) unchanged, and four (17%) with recanalization. In small aneurysms with wide necks, six (25%) had progressive thrombosis, eight (33%) remained unchanged, and 10 (42%) had recanalization. In large aneurysms, two (13%) were unchanged and 13 (87%) had recanalization. Of the giant aneurysms only one (10%) remained unchanged and nine (90%) had recanalization. Overall, 18 aneurysms (25%) exhibited progressive thrombosis, 19 (26%) remained unchanged, and 36 (49%) displayed recanalization on follow-up angiography. During the last 2 years of the study, the recanalization rate decreased and a higher rate of progressive thrombosis was noted in aneurysms with small necks. These positive changes are related to important new technical developments.

Conclusions. Treatment with GDCs appears to be effective and the results permanent in most small aneurysms with small necks. However, there are important technical limitations in the current GDC technology that prevent recanalization in wide-necked or large or giant aneurysms.

Article Information

Address reprint requests to: Motoharu Hayakawa, M.D., Department of Neurosurgery, School of Medicine, Fujita Health University, 1–98 Dengakugakubo, Kutukake, Toyoake, Aichi, 470–1192, Japan.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Angiographic study demonstrating no long-term changes in an aneurysm. Upper Left: Right ICA angiogram (lateral view) revealing a large ICA paraclinoid aneurysm with a wide neck. Upper Right: Angiogram obtained immediately postembolization revealing GDC occlusion of the aneurysm and a residual neck (white arrow). Lower: Follow-up angiogram obtained at 20 months postembolization demonstrating no change in the residual neck (double white arrow).

  • View in gallery

    Angiographic study demonstrating the process of recanalization in an aneurysm. Upper Left: Right ICA angiogram (oblique view) revealing a large anterior communicating artery aneurysm with a wide neck. Upper Right: Angiogram obtained immediately postembolization revealing GDC occlusion of the right aneurysm and a residual neck (arrow). Lower Left: Follow-up angiogram obtained at 6 months posttreatment demonstrating recanalization of the aneurysm (arrowhead). Lower Right: Additional angiogram (lateral view) obtained at 6 months posttreatment demonstrating recanalization (white arrow).

  • View in gallery

    Angiographic study demonstrating the process of progressive thrombosis in an aneurysm. Upper Left: Right ICA angiogram (oblique view) revealing a small anterior communicating artery aneurysm with a wide neck (arrow). Upper Right: Angiogram obtained immediately postembolization revealing GDC occlusion of the aneurysm and a residual neck (arrowhead). Lower: Follow-up angiogram obtained 9 months posttreatment demonstrating progressive thrombosis of the aneurysm (double arrowhead).

  • View in gallery

    Bar graph showing follow-up angiographic results in all aneurysms. In small aneurysms with small necks (S/S), 50% of aneurysms achieved progressive thrombosis and 17% had recanalization. In the small aneurysms with wide necks (S/W), 42% had recanalization. Of the large and giant aneurysms, almost all (87% of large aneurysms and 90% of giant aneurysms) had recanalization and no aneurysm achieved progressive thrombosis.

  • View in gallery

    Bar graphs showing comparisons between early and recent experiences. Upper: Small aneurysms with small necks. During the early experience (1990–1996), 40% of aneurysms achieved progressive thrombosis and the recanalization rate was 20%. During the more recent experience (1997–1998), 57% of aneurysms achieved progressive thrombosis and the recanalization rate was 14%. Lower: Small aneurysms with wide necks. No difference between the two experiences can be noted. Two aneurysms were treated using the balloon-assisted technique. Experience was split into early and recent periods with equal numbers of aneurysms in each group.

References

  • 1.

    Acevedo JCTurjman FSindou M: L'artériographie postopératoire dans la chirurgie des anévrismes intracrâniens. Etude prospective dans une serie consécutive de 267 anévrismes opérés. Neurochirurgie 43:2572841997Acevedo JC Turjman F Sindou M: L'artériographie postopératoire dans la chirurgie des anévrismes intracrâniens. Etude prospective dans une serie consécutive de 267 anévrismes opérés. Neurochirurgie 43:257–284 1997

    • Search Google Scholar
    • Export Citation
  • 2.

    Allcock JMDrake CG: Postoperative angiography in cases of ruptured intracranial aneurysm. J Neurosurg 20:7527591963Allcock JM Drake CG: Postoperative angiography in cases of ruptured intracranial aneurysm. J Neurosurg 20:752–759 1963

    • Search Google Scholar
    • Export Citation
  • 3.

    Bavinzski GKiller MFerraz-Leite Het al: Endovascular therapy of idiopathic cavernous aneurysms over 11 years. AJNR 19:5595651998Bavinzski G Killer M Ferraz-Leite H et al: Endovascular therapy of idiopathic cavernous aneurysms over 11 years. AJNR 19:559–565 1998

    • Search Google Scholar
    • Export Citation
  • 4.

    Brilstra EHRinkel GJEvan der Graaf Yet al: Treatment of intracranial aneurysms by embolization with coils. A systemic review. Stroke 30:4704761999Brilstra EH Rinkel GJE van der Graaf Y et al: Treatment of intracranial aneurysms by embolization with coils. A systemic review. Stroke 30:470–476 1999

    • Search Google Scholar
    • Export Citation
  • 5.

    Burleson ACStrother CMTuritto VTet al: Computer modeling of intracranial saccular and lateral aneurysms for the study of their hemodynamics. Neurosurgery 37:7747841995Burleson AC Strother CM Turitto VT et al: Computer modeling of intracranial saccular and lateral aneurysms for the study of their hemodynamics. Neurosurgery 37:774–784 1995

    • Search Google Scholar
    • Export Citation
  • 6.

    Byrne JVMolyneux AJBrennan RPet al: Embolisation of recently ruptured intracranial aneurysms. J Neurol Neurosurg Psychiatry 59:6166201995Byrne JV Molyneux AJ Brennan RP et al: Embolisation of recently ruptured intracranial aneurysms. J Neurol Neurosurg Psychiatry 59:616–620 1995

    • Search Google Scholar
    • Export Citation
  • 7.

    Cognard CWeill ACastaings Let al: Intracranial berry aneurysms: angiographic and clinical results after endovascular treatment. Radiology 206:4995101998Cognard C Weill A Castaings L et al: Intracranial berry aneurysms: angiographic and clinical results after endovascular treatment. Radiology 206:499–510 1998

    • Search Google Scholar
    • Export Citation
  • 8.

    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
  • 9.

    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
  • 10.

    Eskridge JMSong JK: Endovascular embolization of 150 basilar tip aneurysms with Guglielmi detachable coils: results of the Food and Drug Administration multicenter clinical trial. J Neurosurg 89:81861998Eskridge JM Song JK: Endovascular embolization of 150 basilar tip aneurysms with Guglielmi detachable coils: results of the Food and Drug Administration multicenter clinical trial. J Neurosurg 89:81–86 1998

    • Search Google Scholar
    • Export Citation
  • 11.

    Fernandez Zubillaga AViñuela FGuglielmi Get al: Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. AJNR 15:8158201994Fernandez Zubillaga A Viñuela F Guglielmi G 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
  • 12.

    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
  • 13.

    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
  • 14.

    Graves VBPerl J JrDuff TAet al: Early treatment of ruptured aneurysms with Guglielmi detachable coils: effect on subsequent bleeding. Neurosurgery 37:6406481995Graves VB Perl J Jr 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
  • 15.

    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
  • 16.

    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
  • 17.

    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
  • 18.

    Gurian JHViñuela FGuglielmi Get al: Endovascular embolization of superior hypophyseal artery aneurysms. Neurosurgery 39:115011561996Gurian JH Viñuela F Guglielmi G et al: Endovascular embolization of superior hypophyseal artery aneurysms. Neurosurgery 39:1150–1156 1996

    • Search Google Scholar
    • Export Citation
  • 19.

    Higashida RTSmith WGress Det al: Intravascular stent and endovascular coil placement for a ruptured fusiform aneurysm of the basilar artery. Case report and review of the literature. J Neurosurg 87:9449491997Higashida RT Smith W Gress D et al: Intravascular stent and endovascular coil placement for a ruptured fusiform aneurysm of the basilar artery. Case report and review of the literature. J Neurosurg 87:944–949 1997

    • Search Google Scholar
    • Export Citation
  • 20.

    Horowitz MPurdy PKopitnik Tet al: Aneurysm retreatment after Guglielmi detachable coil and nondetachable coil embolization: report of nine cases and review of the literature. Neurosurgery 44:7127201999Horowitz M Purdy P Kopitnik T et al: Aneurysm retreatment after Guglielmi detachable coil and nondetachable coil embolization: report of nine cases and review of the literature. Neurosurgery 44:712–720 1999

    • Search Google Scholar
    • Export Citation
  • 21.

    Horowitz MBPurdy PDBurns Det al: Scanning electron microscopic findings in a basilar tip aneurysm embolized with Guglielmi detachable coils. AJNR 18:6886901997Horowitz MB Purdy PD Burns D et al: Scanning electron microscopic findings in a basilar tip aneurysm embolized with Guglielmi detachable coils. AJNR 18:688–690 1997

    • Search Google Scholar
    • Export Citation
  • 22.

    Kuether TANesbit GMBarnwell SL: Clinical and angiographic outcomes, with treatment data, for patients with cerebral aneurysms treated with Guglielmi detachable coils: a single-center experience. Neurosurgery 43:101610251998Kuether TA Nesbit GM Barnwell SL: Clinical and angiographic outcomes with treatment data for patients with cerebral aneurysms treated with Guglielmi detachable coils: a single-center experience. Neurosurgery 43:1016–1025 1998

    • Search Google Scholar
    • Export Citation
  • 23.

    Lanzino GWakhloo AKFessler RDet al: Efficacy and current limitations of intravascular stents for intracranial internal carotid, vertebral, and basilar artery aneurysms. J Neurosurgery 91:5385461999Lanzino G Wakhloo AK Fessler RD et al: Efficacy and current limitations of intravascular stents for intracranial internal carotid vertebral and basilar artery aneurysms. J Neurosurgery 91:538–546 1999

    • Search Google Scholar
    • Export Citation
  • 24.

    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
  • 25.

    Lylyk PCeratto RHurvitz Det al: Treatment of a vertebral dissecting aneurysm with stents and coils: technical case report. Neurosurgery 43:3853881998Lylyk P Ceratto R Hurvitz D et al: Treatment of a vertebral dissecting aneurysm with stents and coils: technical case report. Neurosurgery 43:385–388 1998

    • Search Google Scholar
    • Export Citation
  • 26.

    Macdonald RLWallace MCKestle JRW: Role of angiography following aneurysm surgery. J Neurosurg 79:8268321993Macdonald RL Wallace MC Kestle JRW: Role of angiography following aneurysm surgery. J Neurosurg 79:826–832 1993

    • Search Google Scholar
    • Export Citation
  • 27.

    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
  • 28.

    Mericle RALanzino GWakhloo AKet al: Stenting and secondary coiling of intracranial internal carotid artery aneurysm: technical case report. Neurosurgery 43:122912341998Mericle RA Lanzino G Wakhloo AK et al: Stenting and secondary coiling of intracranial internal carotid artery aneurysm: technical case report. Neurosurgery 43:1229–1234 1998

    • Search Google Scholar
    • Export Citation
  • 29.

    Mizoi KYoshimoto TTakahashi Aet al: A pitfall in the surgery of a recurrent aneurysm after coil embolization and its histological observation: technical case report. Neurosurgery 39:1651691996Mizoi K Yoshimoto T Takahashi A et al: A pitfall in the surgery of a recurrent aneurysm after coil embolization and its histological observation: technical case report. Neurosurgery 39:165–169 1996

    • Search Google Scholar
    • Export Citation
  • 30.

    Molyneux AJEllison DWMorris Jet al: Histological findings in giant aneurysms treated with Guglielmi detachable coils. Report of two cases with autopsy correlation. J Neurosurgery 83:1291321995Molyneux AJ Ellison DW Morris J et al: Histological findings in giant aneurysms treated with Guglielmi detachable coils. Report of two cases with autopsy correlation. J Neurosurgery 83:129–132 1995

    • Search Google Scholar
    • Export Citation
  • 31.

    Moret JCognard CWeill Aet al: La technique de reconstruction dans le traitement de 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 de 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
  • 32.

    Moret JPierot LBoulin Aet al: “Remodelling” of the arterial wall of the parent vessel in the endovascular treatment of intracranial aneurysms. Neuroradiology 36 (Suppl 1):S831994 (Abstract)Moret J Pierot L Boulin A et al: “Remodelling” of the arterial wall of the parent vessel in the endovascular treatment of intracranial aneurysms. Neuroradiology 36 (Suppl 1):S83 1994 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 33.

    Murayama YSuzuki YViñuela Fet al: Development of a biologically active Guglielmi detachable coil for the treatment of cerebral aneurysms. Part I: in vitro study. AJNR 20:198619911999Murayama Y Suzuki Y Viñuela F et al: Development of a biologically active Guglielmi detachable coil for the treatment of cerebral aneurysms. Part I: in vitro study. AJNR 20:1986–1991 1999

    • Search Google Scholar
    • Export Citation
  • 34.

    Murayama YViñuela FDuckwiler GRet al: Embolization of incidental cerebral aneurysms by using the Guglielmi detachable coil system. J Neurosurg 90:2072141999Murayama Y Viñuela F Duckwiler GR et al: Embolization of incidental cerebral aneurysms by using the Guglielmi detachable coil system. J Neurosurg 90:207–214 1999

    • Search Google Scholar
    • Export Citation
  • 35.

    Murayama YViñuela FSuzuki Yet al: Development of biologically active Guglielmi detachable coil for the treatment of cerebral aneurysms. Part II: an experimental study in a swine aneurysm model. AJNR 20:199219991999Murayama Y Viñuela F Suzuki Y et al: Development of biologically active Guglielmi detachable coil for the treatment of cerebral aneurysms. Part II: an experimental study in a swine aneurysm model. AJNR 20:1992–1999 1999

    • Search Google Scholar
    • Export Citation
  • 36.

    Murayama YViñuela FSuzuki Yet al: Ion implantation and protein coating of detachable coils for endovascular treatment of cerebral aneurysms: concepts and preliminary results in swine models. Neurosurgery 40:123312441997Murayama Y Viñuela F Suzuki Y et al: Ion implantation and protein coating of detachable coils for endovascular treatment of cerebral aneurysms: concepts and preliminary results in swine models. Neurosurgery 40:1233–1244 1997

    • Search Google Scholar
    • Export Citation
  • 37.

    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
  • 38.

    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
  • 39.

    Richling BGruber ABavinzski Get al: GDC-system embolization for brain aneurysms—location and follow-up. Acta Neurochir 134:1771831995Richling B Gruber A Bavinzski G et al: GDC-system embolization for brain aneurysms—location and follow-up. Acta Neurochir 134:177–183 1995

    • Search Google Scholar
    • Export Citation
  • 40.

    Stiver SIPorter PJWillinsky RAet al: Acute human histopathology of an intracranial aneurysm treated using Guglielmi detachable coils: case report and review of the literature. Neurosurgery 43:120312081998Stiver SI Porter PJ Willinsky RA et al: Acute human histopathology of an intracranial aneurysm treated using Guglielmi detachable coils: case report and review of the literature. Neurosurgery 43:1203–1208 1998

    • Search Google Scholar
    • Export Citation
  • 41.

    Tsutsumi TUeki KUsui Met al: Risk of recurrent subarachnoid hemorrhage after complete obliteration of cerebral aneurysms. Stroke 29:251125131998Tsutsumi T Ueki K Usui M et al: Risk of recurrent subarachnoid hemorrhage after complete obliteration of cerebral aneurysms. Stroke 29:2511–2513 1998

    • Search Google Scholar
    • Export Citation
  • 42.

    Uda KGoto KOgata Net al: Embolization of cerebral aneurysms using Guglielmi detachable coils—problems and treatment plans in the acute stage after subarachnoid hemorrhage and long-term efficiency. Neurol Med Chir 38:1431541998Uda K Goto K Ogata N et al: Embolization of cerebral aneurysms using Guglielmi detachable coils—problems and treatment plans in the acute stage after subarachnoid hemorrhage and long-term efficiency. Neurol Med Chir 38:143–154 1998

    • Search Google Scholar
    • Export Citation
  • 43.

    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

TrendMD

Cited By

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 127 127 10
Full Text Views 161 161 6
PDF Downloads 113 113 1
EPUB Downloads 0 0 0

PubMed

Google Scholar