Neuroradiology

, Volume 48, Issue 12, pp 899–905 | Cite as

Initial primary endovascular treatment in the management of ruptured intracranial aneurysms: a prospective consecutive series

  • Mehdi Mejdoubi
  • Michel Gigaud
  • Michel Trémoulet
  • Jean-François Albucher
  • Christophe Cognard
Interventional Neuroradiology

Abstract

Introduction

From January 1998 to December 2002, endovascular treatment (EVT) was used as first intention in all patients with ruptured aneurysms. The objective of this study was to analyze the results of this therapeutic strategy.

Methods

Among 401 patients admitted with a subarachnoid hemorrhage (SAH), 73 (18%) had a nonaneurysmal perimesencephalic SAH, 28 were not explored by angiography due to very poor clinical status, and 28 with aneurysmal SAH were not treated due to poor clinical status. Thus, of the 300 patients with a proven aneurysmal SAH, 272 (83%) were treated. EVT was attempted in 230 patients and was successful in 222 (82%), and clipping was performed in 50 (18%).

Results

Finally, EVT was successful in 234 aneurysms (96.7%) in 222 patients out of 242 aneurysms in 230 patients (some of the patients were treated for more than one aneurysm in the same procedure). EVT-related morbidity occurred in ten patients (4.5%) and mortality in eight (3.6%). Rate of dependency or death (modified Rankin scale 3–5) was 24.5% at 26 months. Initially, complete aneurysm occlusion was obtained in 81%, a dog ear in 3.4%, a neck remnant in 8% and incomplete occlusion in 8.1% of the patients. At follow-up (mean 26 months), the occlusion rate remained stable at 75%.

Conclusion

This consecutive prospective series shows that EVT can be performed routinely as first-intention treatment in most aneurysmal SAH. Using this therapeutic strategy, EVT was performed in 82% of patients with long-term clinical results similar to those of the ISAT study.

Keywords

Ruptured intracranial aneurysms Embolization Endovascular treatment Outcome 

References

  1. 1.
    Baltsavias GS, Byrne JV, Halsey J, Coley SC, Sohn MJ, Molyneux AJ (2000) Effects of timing of coil embolization after aneurysmal subarachnoid hemorrhage on procedural morbidity and outcomes. Neurosurgery 47:1320–1329; discussion 1329–1331PubMedCrossRefGoogle Scholar
  2. 2.
    Byrne JV, Sohn MJ, Molyneux AJ, Chir B (1999) Five-year experience in using coil embolization for ruptured intracranial aneurysms: outcomes and incidence of late rebleeding. J Neurosurg 90:656–663PubMedGoogle Scholar
  3. 3.
    Cognard C, Weill A, Castaings L, Rey A, Moret J (1998) Intracranial berry aneurysms: angiographic and clinical results after endovascular treatment. Radiology 206:499–510PubMedGoogle Scholar
  4. 4.
    Cognard C, Weill A, Spelle L, Piotin M, Castaings L, Rey A, Moret J (1999) Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology 212:348–356PubMedGoogle Scholar
  5. 5.
    Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6:1–9PubMedGoogle Scholar
  6. 6.
    Fridriksson S, Saveland H, Jakobsson KE, Edner G, Zygmunt S, Brandt L, Hillman J (2002) Intraoperative complications in aneurysm surgery: a prospective national study. J Neurosurg 96:515–522PubMedGoogle Scholar
  7. 7.
    Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:1267–1274PubMedCrossRefGoogle Scholar
  8. 8.
    Henkes H, Fischer S, Weber W, Miloslavski E, Felber S, Brew S, Kuehne D (2004) Endovascular coil occlusion of 1811 intracranial aneurysms: early angiographic and clinical results. Neurosurgery 54:268–280; discussion 280–285PubMedCrossRefGoogle Scholar
  9. 9.
    Kassell NF, Torner JC, Haley EC Jr, Jane JA, Adams HP, Kongable GL (1990) The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results. J Neurosurg 73:18–36PubMedGoogle Scholar
  10. 10.
    Kassell NF, Torner JC, Jane JA, Haley EC Jr, Adams HP (1990) The International Cooperative Study on the Timing of Aneurysm Surgery. Part 2: Surgical results. J Neurosurg 73:37–47PubMedGoogle Scholar
  11. 11.
    Kuether TA, Nesbit GM, Barnwell SL (1998) Clinical and angiographic outcomes, with treatment data, for patients with cerebral aneurysms treated with Guglielmi detachable coils: a single-center experience. Neurosurgery 43:1016–1015PubMedCrossRefGoogle Scholar
  12. 12.
    Malisch TW, Guglielmi G, Vinuela F, Duckwiler G, Gobin YP, Martin NA, Frazee JG (1997) Intracranial aneurysms treated with the Guglielmi detachable coil: midterm clinical results in a consecutive series of 100 patients. J Neurosurg 87:176–183PubMedGoogle Scholar
  13. 13.
    Moret J, Cognard C, Weill A, Castaings L, Rey A (1997) Reconstruction technique in the treatment of wide-neck intracranial aneurysms. Long-term angiographic and clinical results. Apropos of 56 cases (in French). J Neuroradiol 24:30–44PubMedGoogle Scholar
  14. 14.
    Murayama Y, Nien YL, Duckwiler G, Gobin YP, Jahan R, Frazee J, Martin N, Vinuela F (2003) Guglielmi detachable coil embolization of cerebral aneurysms: 11 years’ experience. J Neurosurg 98:959–966PubMedGoogle Scholar
  15. 15.
    Ng P, Khangure MS, Phatouros CC, Bynevelt M, ApSimon H, McAuliffe W (2002) Endovascular treatment of intracranial aneurysms with Guglielmi detachable coils: analysis of midterm angiographic and clinical outcomes. Stroke 33:210–217PubMedCrossRefGoogle Scholar
  16. 16.
    Niemann DB, Wills AD, Maartens NF, Kerr RS, Byrne JV, Molyneux AJ (2003) Treatment of intracerebral hematomas caused by aneurysm rupture: coil placement followed by clot evacuation. J Neurosurg 99:843–847PubMedCrossRefGoogle Scholar
  17. 17.
    Rankin J (1957) Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J 2:200–215PubMedGoogle Scholar
  18. 18.
    Raymond J, Roy D (1997) Safety and efficacy of endovascular treatment of acutely ruptured aneurysms. Neurosurgery 41:1235–1245; discussion 1245–1246PubMedCrossRefGoogle Scholar
  19. 19.
    Sluzewski M, van Rooij WJ, Rinkel GJ, Wijnalda D (2003) Endovascular treatment of ruptured intracranial aneurysms with detachable coils: long-term clinical and serial angiographic results. Radiology 227:720–724PubMedGoogle Scholar
  20. 20.
    Teasdale GM, Drake CG, Hunt W, Kassell N, Sano K, Pertuiset B, De Villiers JC (1988) A universal subarachnoid hemorrhage scale: report of a committee of the World Federation of Neurosurgical Societies. J Neurol Neurosurg Psychiatry 51:1457PubMedCrossRefGoogle Scholar
  21. 21.
    Thornton J, Debrun GM, Aletich VA, Bashir Q, Charbel FT, Ausman J (2002) Follow-up angiography of intracranial aneurysms treated with endovascular placement of Guglielmi detachable coils. Neurosurgery 50:239–249; discussion 249–250PubMedCrossRefGoogle Scholar
  22. 22.
    Tummala RP, Chu RM, Madison MT, Myers M, Tubman D, Nussbaum ES (2001) Outcomes after aneurysm rupture during endovascular coil embolization. Neurosurgery 49:1059–1066; discussion 1066–1067PubMedCrossRefGoogle Scholar
  23. 23.
    Vinuela F, Duckwiler G, Mawad M (1997) Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86:475–482PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Mehdi Mejdoubi
    • 1
    • 4
  • Michel Gigaud
    • 2
  • Michel Trémoulet
    • 2
  • Jean-François Albucher
    • 3
  • Christophe Cognard
    • 1
  1. 1.Department of Neuroradiology, Hôpital PurpanUniversity of ToulouseToulouseFrance
  2. 2.Department of Neurosurgery, Hôpital PurpanUniversity of ToulouseToulouseFrance
  3. 3.Department of Neurology, Hôpital PurpanUniversity of ToulouseToulouseFrance
  4. 4.Service de Neuroradiologie, Hôpital PurpanPlace du Dr Baylac, TSA 40031Toulouse CedexFrance

Personalised recommendations