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

  • Interventional Neuroradiology
  • Published:
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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.

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Conflict of interest statement

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Neuroradiology, Hôpital Purpan, University of Toulouse, Toulouse, France

    Mehdi Mejdoubi & Christophe Cognard

  2. Department of Neurosurgery, Hôpital Purpan, University of Toulouse, Toulouse, France

    Michel Gigaud & Michel Trémoulet

  3. Department of Neurology, Hôpital Purpan, University of Toulouse, Toulouse, France

    Jean-François Albucher

  4. Service de Neuroradiologie, Hôpital Purpan, Place du Dr Baylac, TSA 40031, 31059, Toulouse Cedex, France

    Mehdi Mejdoubi

Authors
  1. Mehdi Mejdoubi
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  2. Michel Gigaud
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  3. Michel Trémoulet
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  4. Jean-François Albucher
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  5. Christophe Cognard
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Correspondence to Mehdi Mejdoubi.

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Mejdoubi, M., Gigaud, M., Trémoulet, M. et al. Initial primary endovascular treatment in the management of ruptured intracranial aneurysms: a prospective consecutive series. Neuroradiology 48, 899–905 (2006). https://doi.org/10.1007/s00234-006-0144-6

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  • DOI: https://doi.org/10.1007/s00234-006-0144-6

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