Intraaneurysmal GDC Embolization for Ruptured Aneurysm in the Acute Stage

Abstract

This report focused on our treatment protcol and results on the intraaneurysmal GDC embolization for ruptured aneurysm in the acute stage.

Clinical materials of this study consist of 39 patients who were treated with intraaneurysmal GDC embolization within 72 hours after the onset of subarachnoid hemorrhage from March 1997 to May 1999.

Patients with cerebral aneurysms are always examined as a possible candidate for neurosurgical clipping. If the patient had any difficulties and/or problems on neurosurgical clipping (high age 24, poor grade 12, surgically difficult location 11, systemic disease 2), the patient was treated by intraaneurysmal GDC embolization. GDCs were inserted as tight as possible. Then, spinal drainage was set in patients with thick subarachnoid hemorrhage. Tissue plasminogen activator was administered via the drainage in patients with thicker subarachnoid hemorrhage. Two patients experienced rerupture during peritherapeutic period. Symptomatic vasospasm was observed in 2 patients (5.1%). Good outcome was obtained in 31 out of 34 surviving patients. Symptomatic complication caused by distal embolism occurred in 1 patient, parent artey occlusion in 3 patients. In conclusion, intraaneurysmal GDC embolization is thought to be sufficient regarding prevention of rerup tu re, incidence of vasospasm, and clinical outcome.

Keywords

embolization Guglielmi detachable coil rerupture subarachnoid hemorrhage vasospasm

Get full access to this article

View all access options for this article.

References

Takahashi

Ezura

Toshimoto

: Broad neck basilar tip aneurysm treated by neck plastic intra-aneurysmal GDC embolisation with protective balloon. Intervetional Neuroradiology 3: 167–170, 1997.

Ezura

Takahashi

: Intra-aneurysmal GDC embolization followed by intrathecal tPA administration for poor-grade basilar tip aneurysm. Surg Neurol 47: 144–148, 1997.

Graves

Strother

: Early treatment of ruptured aneurysms with Guglielmi detachable coils: Effect of subsequent bleeding. Neurosurgery 37: 640–648, 1995.

Byrne

Sohn

Molyneux

: Five-year experience in using coil embolization for ruptured intracranial aneurysms: Outcome and incidence of late rebleeding. J Neurosurg 90: 656–663, 1999.

Viñuela

Duckwiler

Mawad

: Guglielmi detachable coil embolization of acute intracranial aneurysm: Perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86: 475–482, 1997.

Malisch

Guglielmi

: Intracranial aneurysms treated with the Guglielmi detachable coil: Midterm clinical results in a consecutive series of 100 patients. J Neurosurg 87: 176–183, 1997.

Debrun

Aletich

: Selection of cerebral aneurysms for treatment using Guglielmi detachable coils: The preliminary university of Illinois at Chicago experience. Neurosurgery 43: 1281–1297, 1998.