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Published on: August 11, 2015
Endovascular surgery as the first-choice treatment for ruptured cerebral aneurysms: how far has it come?
1Department of Neurosurgery, Musashino Red Cross Hospital; Musashino City, Tokyo, Japan.
Insights
Coil embolization is effective for ruptured cerebral aneurysms, especially small ones and those in the vertebrobasilar and anterior cerebral arteries. However, large aneurysms present challenges with packing and recanalization rates.
Area of Science:
- Neurosurgery
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Coil embolization has become a primary treatment for ruptured cerebral aneurysms since 2000.
- Assessing treatment feasibility and outcomes based on aneurysm location is crucial.
Purpose of the Study:
- To evaluate the efficacy and safety of coil embolization for ruptured cerebral aneurysms.
- To determine the treatment success rates and complication profiles based on aneurysm location and size.
Main Methods:
- Retrospective analysis of 170 patients with ruptured cerebral aneurysms treated between September 1997 and December 2002.
- 195 coil embolization sessions were performed, with data collected on aborted cases, complications, and outcomes.
- Aneurysm location, size, volume embolization ratio, and recanalization rates were analyzed.
Main Results:
- 13% of coil embolization sessions were aborted due to technical difficulties like wide aneurysm necks.
- Procedural complications occurred in a small percentage of patients, with generally good outcomes.
- Recanalization rates were higher for large aneurysms (38%) compared to small ones (9%).
- Treatment success varied by location: 89% for vertebrobasilar, 87% for anterior cerebral, 65% for internal carotid, and 24% for middle cerebral artery aneurysms.
Conclusions:
- Coil embolization is a successful treatment for many ruptured cerebral aneurysms, particularly small ones and those in the vertebrobasilar and anterior cerebral arteries.
- Technical challenges and higher recanalization rates necessitate careful consideration for large aneurysms.
- The location of the aneurysm significantly impacts the feasibility and success of coil embolization.
Summary:
One hundred and seventy patients with ruptured cerebral aneurysms were treated by coil embolization from September 1997 to December 2002. After January 2000, coil embolization was selected as the first-choice treatment for ruptured aneurysms. During this period, the authors investigated the number of aborted cases, the number of complications, and how many patients could be treated by coil embolization according to the locations of ruptured cerebral aneurysms. One hundred and ninety-five sessions were performed on 170 patients, and 13 sessions (6.7%) were aborted mainly because of the difficulty of the approach and the wide necks of the aneurysms. In four patients, although procedural perforation and haemorrhage occurred, the outcome was good or excellent. Eight poorgrade patients experienced haemorrhage after coil embolization and seven patients died. The volume embolization ratios of small and large aneurysms were 27% and 21%, and the recanalization of small and large aneurysms occurred in 9% and 38% of patients, respectively. From January 2000 to December 2002, 119 (66%) of 180 ruptured cerebral aneurysms were treated by coil embolization. According to the location of aneurysms, 89% vertebrobasilar, 87% anterior cerebral, 65% internal carotid and 24% middle cerebral artery aneurysms could be treated by coil embolization. Because the tight packing of large aneurysms was difficult, the recanalization rate of large aneurysms was high. However, the results of small aneurysms were satisfactory. Almost 90% of vertebrobasilar and anterior cerebral artery aneurysms could be treated by coil embolization.
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