Abstract
The treatment of cerebral aneurysms is changing from surgical clipping to endovascular coiling (EVC) in many neurovascular centres. The aim of this study was to evaluate the technical results and clinical outcome at 6 months in a consecutive series of subarachnoid hemorrhage (SAH) patients treated with EVC, in a situation when the EVC had been established very rapidly as the first line of treatment at a neurovascular centre. The patient material comprised 239 SAH patients (155 women and 84 men, mean age 55 years, age range 16–81) allocated to EVC as the first line of treatment in the acute stage (within 3 weeks of rupture) between September 1996 and December 2000. Clinical grade on admission was Hunt & Hess (H&H) I and II in 42%, H&H III in 25% and H&H grade IV and V in 33% of the patients. The aneurysm was located in the anterior circulation in 82% of the cases. EVC was performed on days 0–3 in 77% of the cases. EVC of the target aneurysm was able to be completed in 222 patients (93%). Complete occlusion was achieved in 126 patients (53%). Procedural complications occurred in 39 patients (16%). Favourable clinical outcome was observed in 57%, severe disability in 28% and poor outcome in 14% of the patients. Favourable outcome was achieved in 77% of H&H I and II patients and in 43% of H&H III–V patients. The multivariate logistic regression analysis revealed that younger age, good neurological grade on admission, absence of intracerebral hematoma and intraventricular hematoma respectively, ICA-PcomA aneurysm location, later treatment and absence of complications were significant predictors of favourable outcome. After interventional training and installation of the X-ray system, the introduction and establishment of EVC at a neurovascular unit can be done in a short period of time and with favourable results. Future studies must concentrate on identifying factors of importance for the choice of interventional or surgical therapy. The results of this study indicate that endovascular therapy may be particularly beneficial in poor-grade patients and in patients with aneurysms in the ICA-PcomA territory.
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References
Dandy WE (1938) Intracranial aneurysm of internal carotid artery. Cured by operation. Ann Surg 107:654–659
Guglielmi G, Vinuela F, Dion J, Duckwiler G (1991) Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: preliminary clinical experience. J Neurosurg 75:8–14
Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R (2002) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:1267–1274
Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–20
Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6:1–9
Enblad P, Persson L (1997) Impact on clinical outcome of secondary brain insults during the neurointensive care of patients with subarachnoid haemorrhage: a pilot study. J Neurol Neurosurg Psychiatry 62:512–516
Teasdale GM, Pettigrew LE, Wilson JT, Murray G, Jennett B (1998) Analyzing outcome of treatment of severe head injury: a review and update on advancing the use of the Glasgow outcome scale. J Neurotrauma 15:587–597
Wilson JT, Pettigrew LE, Teasdale GM (1998) Structured interviews for the Glasgow outcome scale and the extended Glasgow outcome scale: guidelines for their use. J Neurotrauma 15:573–585
Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet 1:480–484
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 1329–1331
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 90:656–663
Versari PP, Cenzato M, Tartara F, Righi C, Simionato F, Sganzerla E, Marina R, Gaini SM, Scotti G, Giovanelli M (2000) Introduction of GDC embolization in the clinical practice as treatment synergical to surgery: impact on overall outcome of patients with subarachnoid hemorrhage. Acta Neurochir (Wien) 142:677–683; Discussion 683–674
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 98:959–966
Debrun GM, Aletich VA, Kehrli P, Misra M, Ausman JI, Charbel F (1998) Selection of cerebral aneurysms for treatment using Guglielmi detachable coils: the preliminary University of Illinois at Chicago experience. Neurosurgery 43:1281–1295; Discussion 1296–1287
Leber KA, Klein GE, Trummer M, Eder HG (1998) Intracranial aneurysms: a review of endovascular and surgical treatment in 248 patients. Minim Invasive Neurosurg 41:81–85
Lot G, Houdart E, Cophignon J, Casasco A, George B (1999) Combined management of intracranial aneurysms by surgical and endovascular treatment. Modalities and results from a series of 395 cases. Acta Neurochir (Wien) 141:557–562
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 43:1016–1025
Friedman JA, Nichols DA, Meyer FB, Pichelmann MA, McIver JI, Toussaint LG III, Axley PL, Brown RD Jr (2003) Guglielmi detachable coil treatment of ruptured saccular cerebral aneurysms: retrospective review of a 10-year single-center experience. AJNR Am J Neuroradiol 24:526–533
Kahara VJ, Seppanen SK, Kuurne T, Laasonen EM (1999) Patient outcome after endovascular treatment of intracranial aneurysms with reference to microsurgical clipping. Acta Neurol Scand 99:284–290
Brilstra EH, Rinkel GJ, van der Graaf Y, van Rooij WJ, Algra A (1999) Treatment of intracranial aneurysms by embolization with coils: a systematic review. Stroke 30:470–476
Koivisto T, Vanninen R, Hurskainen H, Saari T, Hernesniemi J, Vapalahti M (2000) Outcomes of early endovascular versus surgical treatment of ruptured cerebral aneurysms. A prospective randomized study. Stroke 31:2369–2377
Raftopoulos C, Mathurin P, Boscherini D, Billa RF, Van Boven M, Hantson P (2000) Prospective analysis of aneurysm treatment in a series of 103 consecutive patients when endovascular embolization is considered the first option. J Neurosurg 93:175–182
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This study was supported by grants from The Swedish Research Council (2002/A0799) and from the Research Funds of Örebro County Council. The study was approved by the local research ethics committee in Uppsala, Sweden (Ups Dnr 01-104).
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Norbäck, O., Gál, G., Johansson, M. et al. The establishment of endovascular aneurysm coiling at a neurovascular unit: report of experience during early years. Neuroradiology 47, 144–152 (2005). https://doi.org/10.1007/s00234-004-1300-5
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DOI: https://doi.org/10.1007/s00234-004-1300-5