Guglielmi Detachable Coil embolization of cerebral aneurysms: 11 years' experience

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Object. The authors report on their 11 years' experience with embolization of cerebral aneurysms using Guglielmi Detachable Coil (GDC) technology and on the attendant anatomical and clinical outcomes.

Methods. Since December 1990, 818 patients harboring 916 aneurysms were treated with GDC embolization at University of California at Los Angeles Medical Center. For comparative purposes, the patients were divided into two groups: Group A included their initial 5 years' experience with 230 patients harboring 251 aneurysms and Group B included the later 6 years' experience with 588 patients harboring 665 aneurysms.

Angiographically demonstrated complete occlusion was achieved in 55% of aneurysms and a neck remnant was displayed in 35.4% of lesions. Incomplete embolization was performed in 3.5% of aneurysms, and in 5% occlusion was attempted unsuccessfully. A comparison between the two groups revealed a higher complete embolization rate in patients in Group B compared with that in Group A patients (56.8 and 50.2%, respectively). The overall morbidity/mortality rate was 9.4%.

Angiographic follow ups were obtained in 53.4% of cases of aneurysms, and recanalization was exhibited in 26.1% of aneurysms in Group A and 17.2% of those in Group B. The overall recanalization rate was 20.9%. Note that recanalization was related to the size of the dome and neck of the aneurysm.

Overall incidence of delayed aneurysm rupture was 1.6%, a rate that improved in the past 5 years to 0.5%. Ten of 12 delayed ruptures occurred in large or giant aneurysms.

Conclusions. The clinical and postembolization outcomes in patients treated with the GDC system have improved in the past 5 years. Aneurysm recanalization, however, is still a major limitation of current GDC therapy. Follow-up angiography is mandatory after GDC embolization of cerebral aneurysms. Further technical and device improvements are mandatory to overcome current GDC limitations.

Article Information

Address reprint requests to: Yuichi Murayama, M.D., Division of Interventional Neuroradiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, 10833 LeConte Avenue, CHS, Room B7–146a, Los Angeles, California 90095–1721. email: ymurayama@mednet.ucla.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Bar graph showing aneurysm morphology (aneurysm size/neck size) by group. Aneurysms tended to be smaller in Group B.The incidence of fusiform aneurysms was similar in both groups. N/A = not applicable.

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    Bar graph demonstrating embolization outcome by group. There was an increase in the rate of completely embolized aneurysms and a decrease in the occurrence of neck remnants in Group B.

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    Bar graph showing overall aneurysm size and embolization outcome. From left, bars show complete through attempted embolizations. G = giant; L = large; S/S = small with small neck; S/W = small with wide neck.

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    Bar graph demonstrating immediate clinical outcome in patients in either group and as a whole.

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    Bar graph demonstrating the relationship between patient clinical presentation, and morbidity and mortality rates.

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    Bar graph showing the recanalization rate by aneurysm size. Overall recanalization was observed in 26.1% of aneurysms in Group A and 17.2% in Group B.

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    Bar graph demonstrating further thrombosis rate by aneurysm size.

  • View in gallery

    Bar graph displaying long-term clinical outcome.

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