Causes and management of aneurysmal hemorrhage occurring during embolization with Guglielmi detachable coils

Cameron G. McDougall Department of Radiology, University of California at San Francisco Medical Center, San Francisco, California

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Van V. Halbach Department of Radiology, University of California at San Francisco Medical Center, San Francisco, California

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Christopher F. Dowd Department of Radiology, University of California at San Francisco Medical Center, San Francisco, California

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Randall T. Higashida Department of Radiology, University of California at San Francisco Medical Center, San Francisco, California

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Donald W. Larsen Department of Radiology, University of California at San Francisco Medical Center, San Francisco, California

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Grant B. Hieshima Department of Radiology, University of California at San Francisco Medical Center, San Francisco, California

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Page Range:
87–92
Volume/Issue:
Volume 89: Issue 1
DOI link:
https://doi.org/10.3171/jns.1998.89.1.0087
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Object. The purpose of this review is to describe the incidence, causes, management, and outcome of aneurysmal hemorrhage that occurred in patients during endovascular treatment with the Guglielmi detachable coil (GDC) system.

Methods. At the authors' institution between September 1991 and August 1995, more than 200 patients were treated using GDCs for intracranial aneurysms. The first 200 patients treated in this fashion were reviewed and all who experienced new subarachnoid hemorrhage (SAH) during the procedure were identified. Angiographic studies were also reviewed and patients were contacted for longer-term follow up when possible.

Four patients who experienced intraprocedural SAH were identified. The causes of hemorrhage were believed to be perforation of the aneurysm by the guidewire in one patient, perforation by the microcatheter in a second, and perforation by the delivery wire in a third. The fourth patient had a hemorrhage during injection of contrast material for control angiographic studies after placement of the final coil. One patient died, but the other three experienced no neurological symptoms or recovered without acquiring additional deficits. Overall a procedural hemorrhage rate of 2% was seen, with permanent morbidity and mortality rates of 0% and 0.5%, respectively.

Conclusions. Although SAH during endovascular treatment of intracranial aneurysms remains a significant risk, its incidence is low and a majority of patients can survive without serious sequelae.

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Contributor Notes

Address reprint requests to: Cameron G. McDougall, M.D., Barrow Neurosurgical Associates, Ltd., 2910 North 3rd Avenue, Phoenix, Arizona 85013. email: CMcDougall@theBNI.com.
Address for Dr. Larsen: University of Miami School of Medicine, Miami, Florida.
Address for Dr. Hieshima: St. Joseph's Neuroscience Institute, Orange, California.
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