Selection of Cerebral Aneurysms for Treatment Using Guglielmi Detachable Coils: The Preliminary University of Illinois at Chicago Experience

Selection of Cerebral Aneurysms for Treatment Using Guglielmi Detachable Coils: The Preliminary... AbstractOBJECTIVE:We present our initial experience with Guglielmi detachable coils (GDCs). The aim of this study was to determine the criteria for aneurysms, ruptured or unruptured, that are suitable for this technique. The importance of aneurysm geometry and its impact on the final results are discussed.METHODS:A retrospective analysis of 329 patients with 339 cerebral aneurysms that were treated at the University of Illinois Hospital at Chicago from May 1994 to June 1997 was conducted. One hundred eighty-five patients were treated surgically, and 144 were selected for treatment using GDCs. O f the 144 patients selected for G D C treatment, 55 patients with 55 aneurysms were admitted during the acute phase of subarachnoid hemorrhage and 89 patients with 97 aneurysms had nonruptured aneurysms or were treated after clinical recovery of previously ruptured aneurysms. All procedures were performed with the patients under general anesthesia and with systemic heparinization using live simultaneous biplane roadmapping, with the exception of the first four patients. These patients were treated before the installation of the biplane system. The percentage of aneurysm occlusion was determined at the end of each procedure. Follow-up angiography was scheduled to be performed at 6 months, 1 year, and 2 years after treatment.PATIENT SELECTION:For the initial 25 patients (Group 1), selection for coiling was restricted to nonsurgical candidates or patients in whom coiling was thought to be the best treatment choice, based on medical condition and location of the aneurysm. The geometry of the aneurysm was not considered to be an important factor in the selection for coiling. The remaining patients (Group 2) were selected for coiling based on aneurysm geometry, as determined by pretherapeutic angiography. Aneurysms that were considered to be favorable for coiling included those that had a dome-to-neck ratio of at least 2 and an absolute neck diameter less than 5 mm.RESULTS:The initial 25 patients (Group 1) were treated from May 1994 to February 1995. There were high morbidity and mortality rates, with 56% of the treated aneurysms occluded at 6 months. The remaining patients (Group 2) consisted of 119 patients with 123 aneurysms. There was no mortality directly related to the coiling procedure, and permanent morbidity was limited to 1.0%. Three patients (2.5%) developed transient neurological deficits secondary to the procedure, and seven patients (5.8%) experienced periprocedural complications that did not result in neurological sequelae. The morphological results were strongly correlated to the geometry of the aneurysms, with a complete occlusion rate of 72% among the acutely ruptured aneurysms and 80% among the nonacute aneurysms, when patients were selected for treatment based on the geometry of the aneurysms and the dome-to-neck ratio was at least 2. The occlusion rate dropped to 53% when selection was not based on aneurysm geometry and the dome-to-neck ratio was less than 2. A summary of the morphological outcomes for the Group 2 patients shows that 86% of the aneurysms that initially underwent coiling using G D C s were completely occluded (78% by coils alone, 3.0% in conjunction with surgery, and 5.0% with parent artery occlusion). Residual small neck remnants were present in 11 % of the Group 2 aneurysms (3.0% were scheduled for surgical treatment of residual neck remnant growths not amenable to further endovascular treatment, and 8% were scheduled for initial 6-mo follow-up examinations). Death resulting from unrelated causes before initial follow-up occurred in 3.0% of the patients.CONCLUSION:These preliminary results suggest that using G D C s is a safe technique resulting in low morbidity and mortality rates for the treatment of intracranial aneurysms in appropriately selected patients. The percentage of complete aneurysm delusion is related to the density of coil packing, which is strongly dependent on the geometry of the aneurysm. Optimal results are obtained when the dome-to-neck ratio is at least 2. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Selection of Cerebral Aneurysms for Treatment Using Guglielmi Detachable Coils: The Preliminary University of Illinois at Chicago Experience

Selection of Cerebral Aneurysms for Treatment Using Guglielmi Detachable Coils: The Preliminary University of Illinois at Chicago Experience

Selection of Cerebral Aneurysms for Treatment Using Guglielmi Detachable Coils: The Preliminary University of Illinois at Chicago Experience Gerard M. Debrun, M.D., Victor A. Aletich, M.D., Pierre Kehrli, M.D., Mukesh Misra, M.D., James I. Ausman, M.D., Ph.D., Fady Charbel, M.D. D epartm ents of R a d io lo g y and N eurosurgery (V A A , G M D , MM, JI A, FC), U n ive rsity of Illin o is at C h ic a g o , C h ic a g o , Illin o is, and Departm ent of N eurosurgery (PK), U n iversity of Strasbourg, Strasbourg, France OBJECTIVE: W e present o u r in itia l e x p e rie n c e w ith G u g lie lm i d e tach ab le c o ils ( G D C s ) . The aim of this study w as to determ ine the criteria for an e u rysm s, rup tu red or u n ru p tu red , that are suitable for this te ch n iq u e . The im p o rtan ce o f an eurysm geom etry and its im pact on the fin a l results are d iscu ssed . METHODS: A re tro sp e ctive a n a ly sis o f 329 patients w ith 339 cere b ral aneurysm s that w ere treated at the U n iv e rs ity of Illin o is Hospital at C h ic a g o from M ay 1 9 9 4 to June 1997 w as co n d u cte d . O n e hundred e ig h ty-five patients w ere treated s u rg ic a lly , and 144 were selected fo r treatm ent usin g G D C s . O f the 144 patients selected for G D C treatm ent, 55 patients w ith 55 aneurysms w ere ad m itted d u rin g the acute phase o f su b a ra ch n o id hem orrhage and 89 patients w ith 97 an eu rysm s had nonruptured aneurysm s or were treated after clin ica l recovery of previously ruptured aneurysms. A ll procedures were performed with the patients under general anesthesia and with systemic heparinization using live simultaneous biplane roadm apping, with the exception of the first four patients. These patients were treated before the installation of the biplane system. The percentage of aneurysm occlusion w as determ ined at the end of each procedure. Follow -up angiography was scheduled to be performed at 6 months, 1 year, and 2 years after...
Loading next page...
 
/lp/ou_press/selection-of-cerebral-aneurysms-for-treatment-using-guglielmi-9Tk0My292T
Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199812000-00011
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVE:We present our initial experience with Guglielmi detachable coils (GDCs). The aim of this study was to determine the criteria for aneurysms, ruptured or unruptured, that are suitable for this technique. The importance of aneurysm geometry and its impact on the final results are discussed.METHODS:A retrospective analysis of 329 patients with 339 cerebral aneurysms that were treated at the University of Illinois Hospital at Chicago from May 1994 to June 1997 was conducted. One hundred eighty-five patients were treated surgically, and 144 were selected for treatment using GDCs. O f the 144 patients selected for G D C treatment, 55 patients with 55 aneurysms were admitted during the acute phase of subarachnoid hemorrhage and 89 patients with 97 aneurysms had nonruptured aneurysms or were treated after clinical recovery of previously ruptured aneurysms. All procedures were performed with the patients under general anesthesia and with systemic heparinization using live simultaneous biplane roadmapping, with the exception of the first four patients. These patients were treated before the installation of the biplane system. The percentage of aneurysm occlusion was determined at the end of each procedure. Follow-up angiography was scheduled to be performed at 6 months, 1 year, and 2 years after treatment.PATIENT SELECTION:For the initial 25 patients (Group 1), selection for coiling was restricted to nonsurgical candidates or patients in whom coiling was thought to be the best treatment choice, based on medical condition and location of the aneurysm. The geometry of the aneurysm was not considered to be an important factor in the selection for coiling. The remaining patients (Group 2) were selected for coiling based on aneurysm geometry, as determined by pretherapeutic angiography. Aneurysms that were considered to be favorable for coiling included those that had a dome-to-neck ratio of at least 2 and an absolute neck diameter less than 5 mm.RESULTS:The initial 25 patients (Group 1) were treated from May 1994 to February 1995. There were high morbidity and mortality rates, with 56% of the treated aneurysms occluded at 6 months. The remaining patients (Group 2) consisted of 119 patients with 123 aneurysms. There was no mortality directly related to the coiling procedure, and permanent morbidity was limited to 1.0%. Three patients (2.5%) developed transient neurological deficits secondary to the procedure, and seven patients (5.8%) experienced periprocedural complications that did not result in neurological sequelae. The morphological results were strongly correlated to the geometry of the aneurysms, with a complete occlusion rate of 72% among the acutely ruptured aneurysms and 80% among the nonacute aneurysms, when patients were selected for treatment based on the geometry of the aneurysms and the dome-to-neck ratio was at least 2. The occlusion rate dropped to 53% when selection was not based on aneurysm geometry and the dome-to-neck ratio was less than 2. A summary of the morphological outcomes for the Group 2 patients shows that 86% of the aneurysms that initially underwent coiling using G D C s were completely occluded (78% by coils alone, 3.0% in conjunction with surgery, and 5.0% with parent artery occlusion). Residual small neck remnants were present in 11 % of the Group 2 aneurysms (3.0% were scheduled for surgical treatment of residual neck remnant growths not amenable to further endovascular treatment, and 8% were scheduled for initial 6-mo follow-up examinations). Death resulting from unrelated causes before initial follow-up occurred in 3.0% of the patients.CONCLUSION:These preliminary results suggest that using G D C s is a safe technique resulting in low morbidity and mortality rates for the treatment of intracranial aneurysms in appropriately selected patients. The percentage of complete aneurysm delusion is related to the density of coil packing, which is strongly dependent on the geometry of the aneurysm. Optimal results are obtained when the dome-to-neck ratio is at least 2.

Journal

NeurosurgeryOxford University Press

Published: Dec 1, 1998

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 12 million articles from more than
10,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Unlimited reading

Read as many articles as you need. Full articles with original layout, charts and figures. Read online, from anywhere.

Stay up to date

Keep up with your field with Personalized Recommendations and Follow Journals to get automatic updates.

Organize your research

It’s easy to organize your research with our built-in tools.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

Monthly Plan

  • Read unlimited articles
  • Personalized recommendations
  • No expiration
  • Print 20 pages per month
  • 20% off on PDF purchases
  • Organize your research
  • Get updates on your journals and topic searches

$49/month

Start Free Trial

14-day Free Trial

Best Deal — 39% off

Annual Plan

  • All the features of the Professional Plan, but for 39% off!
  • Billed annually
  • No expiration
  • For the normal price of 10 articles elsewhere, you get one full year of unlimited access to articles.

$588

$360/year

billed annually
Start Free Trial

14-day Free Trial