Endovascular coil occlusion of 473 intracranial aneurysms: angiographic and clinical results
Keywords:
intracranial aneurysm, subarachnoid hemorrhage, embolization, therapeutic, indicators of morbidity and mortality, cerebral angiography, intracranial hemorrhages
Abstract
Introduction. Endovascular therapy is a technique accepted throughout the world for the treatment of ruptured and non-ruptured intracranial aneurysms. In Colombia, however, no summary data have been published that validate the method in terms of occlusion grade and morbimortality.Objective. The clinical and angiographic outcomes were evaluated for endovascular embolization of 473 intracranial aneurysms treated during a 12 year time interval.
Materials and methods. Between 1996-2008, 473 intracranial aneurysms treated by an endovascular approach were included in the current retrospective study. Pre and postprocedural angiographic images were analyzed, and clinical outcome was recorded according to the Glasgow coma scale. Immediate angiographic results and morbimortality were evaluated.
Results. The technical feasibility of the procedure was 96.8%. According to Hunt and Hess scale, 8.7% patients were classified as grade I, 35.7% grade II, 19.2% grade III and 7.8% grades IV/V. Non-ruptured aneurysms had occurred in 28.5% of patients. Immediate procedural angiography demonstrated total occlusion in 69.6%, neck remnant in 17.5% and partial or failed occlusion in 16.1%. Global mortality was 10.4% and procedural mortality was 1.5%. Technique-associated complications presented in 7.6% of treated aneurysms.
Conclusion. Endovascular treatment of intracranial aneurysms was associated with low morbimortality and high technical feasibility. The results are comparable with other published data summaries and supporting the use of the method in Colombia.
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References
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2. Guglielmi G, Vinuela F, Duckwiler G, Dion J, Lylyk P, Berenstein A, et al. Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg. 1992;77:515-24.
3. Tevah J. Tratamiento endovascular de los aneurismas cerebrales: sus comienzos hace 30 años y su desarrollo actual. Rev Chil Radiol. 2003;9:78-85.
4. Ascensio JL, Vargas SA, Jiménez CM, Arias SA. Terapia endovascular en aneurismas vertebrobasilares. Experiencia del grupo neurovascular. Revista Colombiana de Radiología. 2006;17:1986-94.
5. Pascual-Lozano AM, Chamarro-Lázaro R, Soler-Markessinis F, Láinez-Andrés JM. Eficacia y seguridad del tratamiento endovascular de aneurismas cerebrales: experiencia en nuestro medio. Neurología. 2004;19:369-76.
6. Zubillaga A, Guglielmi G, Vinuela F, Duckwiler G. Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatments results. AJNR Am J Neuroradiol. 1994;15:815-20.
7. Massoud T, Guglielmi G, Vinuela F, Duckwiler G. Endovascular treatment of multiple aneurysms involving the posterior intracranial circulation. AJNR Am J Neuroradiol. 1996;17:549-54.
8. Cognard C, Pierot L, Boulin A, Weill A, Tovi M, Castaings L, et al. Intracranial aneurysms: endovascular treatment with mechanical detachable spirals in 60 aneurysms. Radiology. 1997;202:783-92.
9. Pierot L, Boulin A, Castaing L, Rey A, Moret J. Selective occlusion of the basilar artery aneurysms using controlled detachable coils: report of 35 cases. Neurosurgery. 1996;38:948-54.
10. Cognard C, Weill A, Castaings L, Rey A, Moret J. Intracranial berry aneurysms: angiographic and clinical results after endovascular treatment. Radiology. 1998;206:499-510.
11. Cognard C, Weill A, Spelle L, Piotin M, Castaings L, Rey A, et al. Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology. 1999;212:348-56.
12. Gruber A, Killer M, Bavinski G, Richling B. Clinical and angiographic results of endovascular coiling treatment of giant and very large intracranial aneurysms: a 7-year, single-center experience. Neurosurgery. 1999;45:793-803.
13. Malisch TW, Guglielmi G, Vinuela F, Duckwiler G, Gobin YP, Martin NA, et al. Intracranial aneurysms treated with Guglielmi detachable coil: midterm clinical results in a consecutive series of 100 patients. J Neurosurg. 1997;87:176-83.
14. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert AM, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke. 2003;34:1398-403.
15. Friedman JA, Douglas AN, Meyer FB. Guglielmi detachable coil treatment of ruptured saccular cerebral aneurysms: retrospective review of a 10-year single-center experience. AJNR Am J Neuroradiol. 2003;24:526-33.
16. Ng P, Khangure MS, Phatouros CC, Bynevelt M, ApSimon H, McAuliffe W. Endovascular treatment of intracranial aneurysms with Guglielmi detachable coils: analysis of midterm angiographic and clinical outcomes. Stroke. 2002;33:210-7.
17. Byrne JV, Sohn MJ, Molyneux AJ. Five-year experience in using coil embolization for ruptured intracranial aneurysms: outcomes and incidence of late rebleeding. J Neurosurg. 1999;90:656-63.
18. Vanninen R, Koivisto T, Saari T, Hernesniemi J, Vapalahti M. Ruptured intracranial aneurysms: acute endovascular treatment with electrolytically detachable coils: a prospective randomized study. Radiology. 1999;211:325-36.
19. Valle JN, Aymard A, Vicaut E, Reis M, Merland JJ. Endovascular treatment of basilar tip aneurysms with GDC: predictors of immediate and long-term results with multivariate analysis: 6-year experience. Radiology. 2003;226:867-79.
20. Murayama Y, Nien YL, Duckwiler G, Gobin YP, Jahan R, Frazee J, et al. Guglielmi detachable coil embolization of cerebral aneurysms: 11 years experience. J Neurosurg. 2003;98:959-66.
21. Henkes H, Fischer S, Weber W, Miloslavski E, Felber S, Brew S, et al. Endovascular coil occlusion of 1811 intracranial aneurysms: early angiographic and clinical results. Neurosurgery. 2004;54:268-80.
22. Vinuela F, Duckwiler G, Mawad M. Guglielmi G. Detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg. 1997;86:475-82.
23. Solander S, Ulhoa A, Vinuela F, Duckwiler GR, Gobin YP, Martin NA, et al. Endovascular treatment of multiple intracranial aneurysms by using GDC. J Neurosurg. 1999;90:857-64.
24. Gallas S, Pasco A, Cottier JP, Gabrillargues J, Drouineau J, Cognard C, et al. A multicenter study of 705 ruptured intracranial aneurysms treated with Guglielmi detachable coils. AJNR Am J Neuroradiol. 2005;26:1723-31.
25. International Subarachnoid Aneurysm Trial. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized trial. Lancet. 2002;360:1267-74.
26. Sellar R. International Subarachnoid Aneurysm Trial (ISAT): preliminary report. Neurointerventionist. 2002;3:82.
27. Hunt W, Hess R. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J. Neurosurg. 1968;28:14-20.
28. Gabrielsen TO, Greitz T. Normal size of the internal carotid, middle cerebral and anterior cerebral arteries. Acta Radiol Diagn. 1970;10:1-10.
29. Duke BJ, Kindt GW, Breeze RE. Outcome after urgent surgery for grade IV subarachnoid hemorrhage. Surg Neurol. 1981;54:146-50.
30. Gumprecht H, Winkler R, Gerstner W, Lumenta CB. Therapeutic management of grade IV aneurysm patients. Surg Neurol. 1997;47:54-9.
31. Kawanabe Y, Sadato A, Taki W, Hashimoto N. Endovascular occlusion of intracranial aneurysms with Guglielmi detachable coils: Correlation between coil packing density and coil compaction. Acta Neurochir (Wien). 2001;143:451-5.
32. Piotin M, Mandai S, Murphy KJ, Sugiu K, Gailloud P, Martin JB, et al. Dense packing of cerebral aneurysms: An in vitro study with detachable platinum coils. AJNR Am J Neuroradiol. 2000;21:757-60.
33. Hope JK, Byrne JV, Molyneux AJ. Factors influencing successful angiographic occlusion of aneurysms treated by coil embolization. AJNR Am J Neuroradiol. 1999;20:391-9.
34. van Rooij WJ, de Gast A, Sluzewski M, Nijssen PC, Beute GN. Coiling of truly incidental intracranial aneurysms. AJNR Am J Neuroradiol. 2006;27:293-6.
35. Vindlacheruvu RR, Mendelow AD, Mitchell P. Risk-benefit analysis of the treatment of unruptured intracranial aneurysms. J Neurol Neurosurg Psychiatr. 2005;76:234-9.
2. Guglielmi G, Vinuela F, Duckwiler G, Dion J, Lylyk P, Berenstein A, et al. Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg. 1992;77:515-24.
3. Tevah J. Tratamiento endovascular de los aneurismas cerebrales: sus comienzos hace 30 años y su desarrollo actual. Rev Chil Radiol. 2003;9:78-85.
4. Ascensio JL, Vargas SA, Jiménez CM, Arias SA. Terapia endovascular en aneurismas vertebrobasilares. Experiencia del grupo neurovascular. Revista Colombiana de Radiología. 2006;17:1986-94.
5. Pascual-Lozano AM, Chamarro-Lázaro R, Soler-Markessinis F, Láinez-Andrés JM. Eficacia y seguridad del tratamiento endovascular de aneurismas cerebrales: experiencia en nuestro medio. Neurología. 2004;19:369-76.
6. Zubillaga A, Guglielmi G, Vinuela F, Duckwiler G. Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatments results. AJNR Am J Neuroradiol. 1994;15:815-20.
7. Massoud T, Guglielmi G, Vinuela F, Duckwiler G. Endovascular treatment of multiple aneurysms involving the posterior intracranial circulation. AJNR Am J Neuroradiol. 1996;17:549-54.
8. Cognard C, Pierot L, Boulin A, Weill A, Tovi M, Castaings L, et al. Intracranial aneurysms: endovascular treatment with mechanical detachable spirals in 60 aneurysms. Radiology. 1997;202:783-92.
9. Pierot L, Boulin A, Castaing L, Rey A, Moret J. Selective occlusion of the basilar artery aneurysms using controlled detachable coils: report of 35 cases. Neurosurgery. 1996;38:948-54.
10. Cognard C, Weill A, Castaings L, Rey A, Moret J. Intracranial berry aneurysms: angiographic and clinical results after endovascular treatment. Radiology. 1998;206:499-510.
11. Cognard C, Weill A, Spelle L, Piotin M, Castaings L, Rey A, et al. Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology. 1999;212:348-56.
12. Gruber A, Killer M, Bavinski G, Richling B. Clinical and angiographic results of endovascular coiling treatment of giant and very large intracranial aneurysms: a 7-year, single-center experience. Neurosurgery. 1999;45:793-803.
13. Malisch TW, Guglielmi G, Vinuela F, Duckwiler G, Gobin YP, Martin NA, et al. Intracranial aneurysms treated with Guglielmi detachable coil: midterm clinical results in a consecutive series of 100 patients. J Neurosurg. 1997;87:176-83.
14. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert AM, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke. 2003;34:1398-403.
15. Friedman JA, Douglas AN, Meyer FB. Guglielmi detachable coil treatment of ruptured saccular cerebral aneurysms: retrospective review of a 10-year single-center experience. AJNR Am J Neuroradiol. 2003;24:526-33.
16. Ng P, Khangure MS, Phatouros CC, Bynevelt M, ApSimon H, McAuliffe W. Endovascular treatment of intracranial aneurysms with Guglielmi detachable coils: analysis of midterm angiographic and clinical outcomes. Stroke. 2002;33:210-7.
17. Byrne JV, Sohn MJ, Molyneux AJ. Five-year experience in using coil embolization for ruptured intracranial aneurysms: outcomes and incidence of late rebleeding. J Neurosurg. 1999;90:656-63.
18. Vanninen R, Koivisto T, Saari T, Hernesniemi J, Vapalahti M. Ruptured intracranial aneurysms: acute endovascular treatment with electrolytically detachable coils: a prospective randomized study. Radiology. 1999;211:325-36.
19. Valle JN, Aymard A, Vicaut E, Reis M, Merland JJ. Endovascular treatment of basilar tip aneurysms with GDC: predictors of immediate and long-term results with multivariate analysis: 6-year experience. Radiology. 2003;226:867-79.
20. Murayama Y, Nien YL, Duckwiler G, Gobin YP, Jahan R, Frazee J, et al. Guglielmi detachable coil embolization of cerebral aneurysms: 11 years experience. J Neurosurg. 2003;98:959-66.
21. Henkes H, Fischer S, Weber W, Miloslavski E, Felber S, Brew S, et al. Endovascular coil occlusion of 1811 intracranial aneurysms: early angiographic and clinical results. Neurosurgery. 2004;54:268-80.
22. Vinuela F, Duckwiler G, Mawad M. Guglielmi G. Detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg. 1997;86:475-82.
23. Solander S, Ulhoa A, Vinuela F, Duckwiler GR, Gobin YP, Martin NA, et al. Endovascular treatment of multiple intracranial aneurysms by using GDC. J Neurosurg. 1999;90:857-64.
24. Gallas S, Pasco A, Cottier JP, Gabrillargues J, Drouineau J, Cognard C, et al. A multicenter study of 705 ruptured intracranial aneurysms treated with Guglielmi detachable coils. AJNR Am J Neuroradiol. 2005;26:1723-31.
25. International Subarachnoid Aneurysm Trial. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized trial. Lancet. 2002;360:1267-74.
26. Sellar R. International Subarachnoid Aneurysm Trial (ISAT): preliminary report. Neurointerventionist. 2002;3:82.
27. Hunt W, Hess R. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J. Neurosurg. 1968;28:14-20.
28. Gabrielsen TO, Greitz T. Normal size of the internal carotid, middle cerebral and anterior cerebral arteries. Acta Radiol Diagn. 1970;10:1-10.
29. Duke BJ, Kindt GW, Breeze RE. Outcome after urgent surgery for grade IV subarachnoid hemorrhage. Surg Neurol. 1981;54:146-50.
30. Gumprecht H, Winkler R, Gerstner W, Lumenta CB. Therapeutic management of grade IV aneurysm patients. Surg Neurol. 1997;47:54-9.
31. Kawanabe Y, Sadato A, Taki W, Hashimoto N. Endovascular occlusion of intracranial aneurysms with Guglielmi detachable coils: Correlation between coil packing density and coil compaction. Acta Neurochir (Wien). 2001;143:451-5.
32. Piotin M, Mandai S, Murphy KJ, Sugiu K, Gailloud P, Martin JB, et al. Dense packing of cerebral aneurysms: An in vitro study with detachable platinum coils. AJNR Am J Neuroradiol. 2000;21:757-60.
33. Hope JK, Byrne JV, Molyneux AJ. Factors influencing successful angiographic occlusion of aneurysms treated by coil embolization. AJNR Am J Neuroradiol. 1999;20:391-9.
34. van Rooij WJ, de Gast A, Sluzewski M, Nijssen PC, Beute GN. Coiling of truly incidental intracranial aneurysms. AJNR Am J Neuroradiol. 2006;27:293-6.
35. Vindlacheruvu RR, Mendelow AD, Mitchell P. Risk-benefit analysis of the treatment of unruptured intracranial aneurysms. J Neurol Neurosurg Psychiatr. 2005;76:234-9.
How to Cite
1.
Vargas SA, Herrera DA, Cornejo JW. Endovascular coil occlusion of 473 intracranial aneurysms: angiographic and clinical results. Biomed. [Internet]. 2010 Dec. 1 [cited 2025 Apr. 5];30(4):567-76. Available from: https://revistabiomedicaorg.biteca.online/index.php/biomedica/article/view/295
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Published
2010-12-01
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