Intraaneurysmal GDC Embolization for Ruptured Aneurysm in the Acute Stage. Indication and Results

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Vascular Neurology

Background:

• Cerebral aneurysms pose significant risks, especially when ruptured, leading to subarachnoid hemorrhage.
• Neurosurgical clipping is a standard treatment, but patient-specific factors can make it challenging.
• Alternative treatments are crucial for patients unsuitable for conventional surgery.

Purpose of the Study:

• To evaluate the efficacy and safety of intraaneurysmal Guglielmi Detachable Coil (GDC) embolization for ruptured cerebral aneurysms.
• To assess the GDC embolization protocol in the acute phase (within 72 hours of symptom onset).
• To compare outcomes with neurosurgical clipping in specific patient populations.

Main Methods:

• Retrospective analysis of 39 patients treated with intraaneurysmal GDC embolization for ruptured aneurysms.
• GDC coils were inserted tightly; spinal drainage and tissue plasminogen activator were used for severe cases.
• Patient selection prioritized those with contraindications or difficulties for neurosurgical clipping (e.g., high age, poor grade, complex anatomy).

Main Results:

• 31 out of 34 surviving patients achieved a good clinical outcome.
• The procedure demonstrated effectiveness in preventing re-rupture during the peritherapeutic period.
• Complications included symptomatic vasospasm (5.1%), distal embolism (1 patient), and parent artery occlusion (3 patients).

Conclusions:

• Intraaneurysmal GDC embolization is a viable and effective treatment for acute ruptured cerebral aneurysms.
• The technique provides sufficient prevention of re-rupture and favorable clinical outcomes.
• It offers a safe alternative for patients who are poor candidates for neurosurgical clipping.