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Angiographical Follow-up Results of Cerebral Aneurysms Treated by Guglielmi Detachable Coil System
1Department of Surgical Neuroangiography, Nakamura Memorial Hospital; Sapporo, Japan - thyogo@med.nmh.or.jp.
Insights
Long-term follow-up angiography of Guglielmi detachable coil (GDC) treatment for cerebral aneurysms revealed angiographical changes in over half of cases at six months. While no hemorrhages occurred, wide neck aneurysms showed worsening outcomes.
Area of Science:
- Neurosurgery
- Interventional Radiology
- Vascular Neurology
Background:
- Endovascular coiling using the Guglielmi detachable coil (GDC) system is a common treatment for cerebral aneurysms.
- Long-term outcomes and angiographical changes following GDC treatment require thorough investigation.
Purpose of the Study:
- To evaluate the long-term results of endovascular treatment for cerebral aneurysms using the GDC system.
- To analyze angiographical changes and identify factors influencing treatment outcomes at various follow-up intervals.
Main Methods:
- Analysis of 45 cases (49 procedures) of GDC-treated cerebral aneurysms from 1997 to 2000.
- Serial follow-up angiography performed at 6, 12, and 24 months post-procedure.
- Assessment of angiographical changes, including complete occlusion, neck remnant, and partial occlusion.
Main Results:
- Follow-up angiography was achieved in 96% at 6 months, 87% at 12 months, and 88% at 24 months.
- Angiographical changes were observed in 53% of cases at 6-month follow-up.
- Improvements were noted in 12 cases, while 11 cases showed worsening, particularly wide-neck aneurysms. No hemorrhages or re-hemorrhages occurred.
Conclusions:
- GDC treatment demonstrated no post-procedure hemorrhages.
- Tight packing and small neck size correlated with angiographical improvement in side-wall aneurysms.
- Wide neck aneurysms and procedural factors influenced angiographical worsening.
Summary:
To examine the long term results of endovascular treatment of cerebral aneurysms with the Guglielmi detachable coil (GDC) system, follow- up (F/U) angiography was performed at 6, 12 and 24 months after the procedure. We analyzed 45 cases, 49 procedures of GDC treated cerebral aneurysms from 1997.6. to 2000.5. Follow- up angiography was achieved at 6M 43/45 (96%), 12M 29/33 (87%) and 24M 22/25 (88%). Angiographical changes were found 23/43 (53%) of the cases at 6M F/U. There were angiographical improvements in 12 cases (CP: complete occlusion, NR: neck remnant, PA: partial occlusion, PA-CP; 8, NR-CP; 1, PA-NR; 3) and angiographical worsening in 11 cases (CP-NR; 5, CP-PA; 3, PA-PA; 3) at 6M F/U. Two cases had been demonstrating progressive angiographical worsening at 6M and 12M F/U (CP-NR-PA). No angiographical change was found at 24M F/U. There was no case of hemorrhage or re-hemorrhage after GDC treatment. In cases of side-wall aneurysm, tight packing of the inflow side of the aneurysm and small neck aneurysm were thought to be causes of the angiographical improvements. In patients with wide neck aneurysms with partial occlusion result were angiographic worsening at the F/U. Other factors of angiographical worsening were improper working angle at the procedure and improper follow-up angle at the angiography and the intraluminal clot in the case of ruptured aneurysm.
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