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Endovascular occlusion of basilar bifurcation aneurysms with electrolytically detachable coils
G Redekop1, R Willinsky, W Montanera
1Department of Medical Imaging, Toronto Hospital, Canada.
Insights
Endovascular coiling of basilar bifurcation aneurysms shows promise in preventing rebleeding. Long-term follow-up is necessary to confirm the durability of these results for basilar tip aneurysms.
Area of Science:
- Neurosurgery
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Basilar bifurcation aneurysms pose significant treatment challenges.
- Endovascular techniques offer an alternative to open surgical repair.
Purpose of the Study:
- To evaluate the clinical and angiographic outcomes of endovascular occlusion for basilar bifurcation aneurysms using electrolytically detachable coils.
- To identify factors influencing the choice between surgical and endovascular treatment.
Main Methods:
- A prospective study of 40 patients undergoing attempted embolization of basilar bifurcation aneurysms with Guglielmi detachable coils (GDCs).
- Superselective angiography was performed for all patients.
- Clinical and angiographic results were recorded, including aneurysm presentation (subarachnoid hemorrhage, symptomatic, incidental).
Main Results:
- Successful coil placement was achieved in 75% of patients.
- Complete occlusion was obtained in 32.5% initially, with small neck remnants in 32.5%.
- Good recovery was observed in 78% of patients treated after subarachnoid hemorrhage, with a 2.5% procedural mortality and 7.5% permanent morbidity. Complete occlusion was more feasible for small-neck aneurysms (56%) than large-neck aneurysms (14%).
Conclusions:
- Endovascular treatment effectively prevents early rebleeding of basilar bifurcation aneurysms.
- Acceptable morbidity and mortality rates are associated with this endovascular approach.
- Long-term follow-up is crucial to assess the durability of endovascular treatment for these complex aneurysms.
Object:
To describe the clinical and angiographic results of endovascular occlusion of basilar bifurcation aneurysms with electrolytically detachable coils, and to identify factors which should be considered in deciding upon surgical or endovascular treatment.
Methods:
We report our experience with 40 patients in whom occlusion of basilar bifurcation aneurysms with electrolytically detachable coils was attempted. All patients underwent superselective angiography and attempted embolization with Guglielmi detachable coils (GDCs). Angiographic and clinical results were prospectively recorded. Twenty-eight aneurysms presented with subarachnoid hemorrhage (SAH), 2 were symptomatic and 10 were incidental.
Results:
Coils were not placed in 10 patients (25%) because of unfavorable anatomy. Complete aneurysm occlusion was achieved at the time of the initial procedure in 13 (32.5%), small neck remnants were present in 13 (32.5%), and in 4 (10.0%) there was obvious residual contrast filling of the aneurysm body. Of 23 patients successfully coiled after SAH, 20 were Grade 1 to 3 and 3 were grade 4 or 5 at the time of treatment. Eighteen (78%) made a good recovery. Procedural mortality was 2.5% and permanent morbidity was 7.5%. There were no permanent complications in patients with unruptured aneurysms. Complete aneurysm occlusion was possible in 10 (56%) of 18 aneurysms with small necks and 3 (14%) of 22 with large necks. Follow-up angiography in 25 of 28 surviving patients (mean, 12 months) demonstrated stability of all completely occluded aneurysms. Incompletely coiled aneurysms had variable results on follow-up angiograms: 15.4% improved, 69.2% worsened, and 15.4% were stable. No aneurysm bled after treatment during clinical follow-up averaging 22 months.
Conclusions:
Endovascular treatment of basilar bifurcation aneurysms appears to prevent early aneurysm rebleeding with acceptable rates of morbidity and mortality, but long-term follow-up is required.