Guglielmi detachable coil treatment of ruptured saccular cerebral aneurysms: Retrospective review of a 10-year single-center experience

Jonathan A. Friedman, Douglas A. Nichols, Fredric B. Meyer, Mark A. Pichelmann, Jon I. McIver, L. Gerard Toussaint, Patsy L. Axley, Robert D Jr. Brown

Research output: Contribution to journalArticle

119 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE: We retrospectively analyzed our results with Guglielmi detachable coils (GDCs) for the endovascular occlusion of acutely ruptured saccular cerebral aneurysms over 10 years. METHODS: Between 1991-2000, 83 patients (mean age, 56.1 years) with aneurysmal subarachnoid hemorrhage were treated with endovascular GDCs. Patients with aneurysms due to trauma or dissection and those with mycotic or fusiform aneurysms were excluded. Mean follow-up in survivors was 19.1 months, and the mean Hunt-Hess grade at admission was 2.2. Angiographic follow-up was performed in 93% of surviving patients (mean interval, 11.6 months). The basilar caput (34 patients) and anterior communicating artery complex (19 patients) were most commonly treated. RESULTS: Sixty-four patients (77%) had a Glasgow Outcome Scale score (GOS) of 4 or 5, nine (11%) had a score of 2 or 3, and 10 (12%) died. At follow-up, 24 patients (35%) had complete aneurysm occlusion, 18 (26%) had a dog-ear remnant, 24 (35%) had a residual neck, and two (3%) had residual aneurysm filling. No treated aneurysm rebled. Three patients required surgical repair after incomplete endovascular treatment. Two or more GDC occlusion procedures were required in 28 patients (34%). Major procedural complications occurred in two patients (2%), resulting in serious neurologic disability or death. CONCLUSION: Endovascular treatment of ruptured cerebral aneurysms with GDCs has low morbidity, and it facilitates good overall outcomes in patients after subarachnoid hemorrhage. The short-term effectiveness of GDC occlusion in preventing aneurysmal rebleeding was excellent. Durability of the treatment in preventing long-term rebleeding as compared with direct surgical clipping warrants further study. Advances in device technology and technique may improve future outcomes.

Original languageEnglish (US)
Pages (from-to)526-533
Number of pages8
JournalAmerican Journal of Neuroradiology
Volume24
Issue number3
StatePublished - Mar 2003

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Intracranial Aneurysm
Aneurysm
Therapeutics
Subarachnoid Hemorrhage
Glasgow Outcome Scale
Infected Aneurysm
Ruptured Aneurysm
Nervous System
Ear
Survivors
Dissection
Neck
Arteries
Dogs
Technology
Morbidity
Equipment and Supplies

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

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Guglielmi detachable coil treatment of ruptured saccular cerebral aneurysms : Retrospective review of a 10-year single-center experience. / Friedman, Jonathan A.; Nichols, Douglas A.; Meyer, Fredric B.; Pichelmann, Mark A.; McIver, Jon I.; Toussaint, L. Gerard; Axley, Patsy L.; Brown, Robert D Jr.

In: American Journal of Neuroradiology, Vol. 24, No. 3, 03.2003, p. 526-533.

Research output: Contribution to journalArticle

Friedman, JA, Nichols, DA, Meyer, FB, Pichelmann, MA, McIver, JI, Toussaint, LG, Axley, PL & Brown, RDJ 2003, 'Guglielmi detachable coil treatment of ruptured saccular cerebral aneurysms: Retrospective review of a 10-year single-center experience', American Journal of Neuroradiology, vol. 24, no. 3, pp. 526-533.
Friedman, Jonathan A. ; Nichols, Douglas A. ; Meyer, Fredric B. ; Pichelmann, Mark A. ; McIver, Jon I. ; Toussaint, L. Gerard ; Axley, Patsy L. ; Brown, Robert D Jr. / Guglielmi detachable coil treatment of ruptured saccular cerebral aneurysms : Retrospective review of a 10-year single-center experience. In: American Journal of Neuroradiology. 2003 ; Vol. 24, No. 3. pp. 526-533.
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abstract = "BACKGROUND AND PURPOSE: We retrospectively analyzed our results with Guglielmi detachable coils (GDCs) for the endovascular occlusion of acutely ruptured saccular cerebral aneurysms over 10 years. METHODS: Between 1991-2000, 83 patients (mean age, 56.1 years) with aneurysmal subarachnoid hemorrhage were treated with endovascular GDCs. Patients with aneurysms due to trauma or dissection and those with mycotic or fusiform aneurysms were excluded. Mean follow-up in survivors was 19.1 months, and the mean Hunt-Hess grade at admission was 2.2. Angiographic follow-up was performed in 93{\%} of surviving patients (mean interval, 11.6 months). The basilar caput (34 patients) and anterior communicating artery complex (19 patients) were most commonly treated. RESULTS: Sixty-four patients (77{\%}) had a Glasgow Outcome Scale score (GOS) of 4 or 5, nine (11{\%}) had a score of 2 or 3, and 10 (12{\%}) died. At follow-up, 24 patients (35{\%}) had complete aneurysm occlusion, 18 (26{\%}) had a dog-ear remnant, 24 (35{\%}) had a residual neck, and two (3{\%}) had residual aneurysm filling. No treated aneurysm rebled. Three patients required surgical repair after incomplete endovascular treatment. Two or more GDC occlusion procedures were required in 28 patients (34{\%}). Major procedural complications occurred in two patients (2{\%}), resulting in serious neurologic disability or death. CONCLUSION: Endovascular treatment of ruptured cerebral aneurysms with GDCs has low morbidity, and it facilitates good overall outcomes in patients after subarachnoid hemorrhage. The short-term effectiveness of GDC occlusion in preventing aneurysmal rebleeding was excellent. Durability of the treatment in preventing long-term rebleeding as compared with direct surgical clipping warrants further study. Advances in device technology and technique may improve future outcomes.",
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AU - Friedman, Jonathan A.

AU - Nichols, Douglas A.

AU - Meyer, Fredric B.

AU - Pichelmann, Mark A.

AU - McIver, Jon I.

AU - Toussaint, L. Gerard

AU - Axley, Patsy L.

AU - Brown, Robert D Jr.

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N2 - BACKGROUND AND PURPOSE: We retrospectively analyzed our results with Guglielmi detachable coils (GDCs) for the endovascular occlusion of acutely ruptured saccular cerebral aneurysms over 10 years. METHODS: Between 1991-2000, 83 patients (mean age, 56.1 years) with aneurysmal subarachnoid hemorrhage were treated with endovascular GDCs. Patients with aneurysms due to trauma or dissection and those with mycotic or fusiform aneurysms were excluded. Mean follow-up in survivors was 19.1 months, and the mean Hunt-Hess grade at admission was 2.2. Angiographic follow-up was performed in 93% of surviving patients (mean interval, 11.6 months). The basilar caput (34 patients) and anterior communicating artery complex (19 patients) were most commonly treated. RESULTS: Sixty-four patients (77%) had a Glasgow Outcome Scale score (GOS) of 4 or 5, nine (11%) had a score of 2 or 3, and 10 (12%) died. At follow-up, 24 patients (35%) had complete aneurysm occlusion, 18 (26%) had a dog-ear remnant, 24 (35%) had a residual neck, and two (3%) had residual aneurysm filling. No treated aneurysm rebled. Three patients required surgical repair after incomplete endovascular treatment. Two or more GDC occlusion procedures were required in 28 patients (34%). Major procedural complications occurred in two patients (2%), resulting in serious neurologic disability or death. CONCLUSION: Endovascular treatment of ruptured cerebral aneurysms with GDCs has low morbidity, and it facilitates good overall outcomes in patients after subarachnoid hemorrhage. The short-term effectiveness of GDC occlusion in preventing aneurysmal rebleeding was excellent. Durability of the treatment in preventing long-term rebleeding as compared with direct surgical clipping warrants further study. Advances in device technology and technique may improve future outcomes.

AB - BACKGROUND AND PURPOSE: We retrospectively analyzed our results with Guglielmi detachable coils (GDCs) for the endovascular occlusion of acutely ruptured saccular cerebral aneurysms over 10 years. METHODS: Between 1991-2000, 83 patients (mean age, 56.1 years) with aneurysmal subarachnoid hemorrhage were treated with endovascular GDCs. Patients with aneurysms due to trauma or dissection and those with mycotic or fusiform aneurysms were excluded. Mean follow-up in survivors was 19.1 months, and the mean Hunt-Hess grade at admission was 2.2. Angiographic follow-up was performed in 93% of surviving patients (mean interval, 11.6 months). The basilar caput (34 patients) and anterior communicating artery complex (19 patients) were most commonly treated. RESULTS: Sixty-four patients (77%) had a Glasgow Outcome Scale score (GOS) of 4 or 5, nine (11%) had a score of 2 or 3, and 10 (12%) died. At follow-up, 24 patients (35%) had complete aneurysm occlusion, 18 (26%) had a dog-ear remnant, 24 (35%) had a residual neck, and two (3%) had residual aneurysm filling. No treated aneurysm rebled. Three patients required surgical repair after incomplete endovascular treatment. Two or more GDC occlusion procedures were required in 28 patients (34%). Major procedural complications occurred in two patients (2%), resulting in serious neurologic disability or death. CONCLUSION: Endovascular treatment of ruptured cerebral aneurysms with GDCs has low morbidity, and it facilitates good overall outcomes in patients after subarachnoid hemorrhage. The short-term effectiveness of GDC occlusion in preventing aneurysmal rebleeding was excellent. Durability of the treatment in preventing long-term rebleeding as compared with direct surgical clipping warrants further study. Advances in device technology and technique may improve future outcomes.

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