Endosaccular embolization for cerebral aneurysms - Aiming at a less invasive and safer treatment

The authors reviewed 48 patients who underwent endosaccular embolization using detachable coils for the treatment of cerebral aneurysms between March 1993 and February 1997. Aneurysm size was small in 25 patients, large in 17, and giant in 6. The aneurysms were located in the anterior circulation in 21 patients and the posterior circulation in 27 patients. Neurological presentation included subarachnoid hemorrhage in 16, mass effect in 5, transient ischemic attack in 2, combination with other neurological disease in 4, and incidental in 21 patients. The detachable coils used were Guglielmi electrodetachable coils (GDC) in 8 patients, interlocking detachable coils (IDC) in 36 patients, and immediately electrodetachable coils (IEDC) in 4 patients (including 3 patients treated with both IDC and IEDC). Immediate angiographic results were satisfactory (total obliteration in 14 patients, subtotal obliteration in 23, partial obliteration in 7, failure in 4). Angiographic follow-up in 29 patients (mean follow-up interval: 9 months) revealed the rate of obliteration to be unchanged in 19, increased in 1, and decreased in 9. The cause of decrease in these 9 patients were coil compaction in 5 and coils buried into the intraluminal thrombus in 4 patients. Neither further hemorrhage nor thromboembolism were observed during the clinical follow-up period (mean follow-up interval: 15 months). Outcome was GR in 35, MD in 1, SD in 5, VS in 2, and Death in 5. Bad outcomes were related primarily to either initial brain damage due to subarachnoid hemorrhage or procedural complications. Complications included hemorrhage during the procedure in 5 patients, thromboembolism in 1 patient, parent artery occlusion in 1 patients, and parent artery dissection in 1 patient. On the basis of these observations, the authors discussed the important technical aspects and pitfalls of this treatment in order to achieve less invasive and safer treatment with this technology. Management to deal with each complication during the procedure was also discussed.